Original Medicare: It May Not Be Enough

Medicare is so important for American seniors, but if you’re turning 65, you should know that it isn’t a “cover all” insurance. Medicare has many gaps, which are filled by adding additional insurance products to your healthcare arsenal. Medicare Advantage plans, Medicare Part D, and Medigap policies are all affordable and attractive ways to supplement your federal insurance. Keep reading for info on these and advice on how to choose which is right for you.

Don’t let the terms trip you up

Medicare, like all insurance, isn’t as straightforward as it might seem on the surface. The biggest struggle for many seniors is simply sorting through the terminology used to describe coverage options. Medicare.org’s list of common Medicare terms is a great go-to resource when you need a refresher.  

Know yourself

Before you apply for any Medicare coverage, take some time to get to know your needs. You may be so used to your workplace insurance that you run on autopilot, giving little thought to what that plan pays, since you only have a copay and your premiums are deducted automatically from your salary. But Medicare is not like employer-sponsored insurance. For one, as Forbes explains, there is no family plan. If you and your spouse turn 65 the same year, you’re both on your own.

Determine what benefits you actually use, and think about your family's history of disease and late-age disability. Some Medicare Advantage plans offer more comprehensive coverage for things like doctor visits and hospital stays. If you routinely take prescription medications, you’ll also want to compare Part D plans (if you’re sticking to Original Medicare) or look for an Advantage plan with excellent drug benefits. Kiplinger also suggests checking that your doctors are able to take Medicare patients. Many will not, due to low payouts and confusing and mandatory red tape they have to go through.

What can you afford?

Original Medicare only covers basic services, such as routine health screenings, hospital stays, and a few other necessities. If that’s all you need and you have the money to pay out of pocket if you have a medical emergency, then you can stick to Original Medicare. However, many seniors opt to add a Medigap policy, which is essentially a monthly fee you pay to reduce your overall expenses. Medigap isn’t cheap, though, and can significantly increase your monthly expenses.

Medicare Advantage plans, like Medigap, go above and beyond Original Medicare. You’ll choose a plan that more closely resembles what you are used to. In fact, Medicare Advantage plans are sold by private insurers, just like your employer’s insurance. You’ll also receive benefits for things that Original Medicare doesn’t cover, such as vision, dental, and hearing. Most even include drug coverage, although each plan is different, and they can change each year.

When it’s time to choose

As more and more Boomers age into Medicare, it’s likely that plans will continue to change to meet their needs and demands. In 2019, Medicare Advantage plans showed signs of this, and many began offering lifestyle coverage (meal delivery, home modification, etc.). Another sign of the times is that you’re no longer committed once you enroll; you have the option to change plans after three or so months if you aren’t happy.

Your insurance agent can help you identify a plan that meets your needs. It might sound complicated, but having options available is a good thing for seniors, since no two of us are alike. From drug coverage to copay considerations, there is a plan out there that fits your lifestyle and budget. You just have to find it.

If you still need assistance, the Medicare Plan Finder tool can help you determine the kind of coverage that’s right for you.

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Guest Article by Sharon Wagner SeniorFriendly.info