Updated: Jan 25, 2022
We have discussed this subject previously but with Medicare season only a couple of months away it seems like this is a good time for a refresher.
We’ll begin with Original Medicare. Original Medicare includes Part A, which is facility coverage. Most of us paid for this during our working years. Part B is outpatient coverage, for which we pay a monthly premium, about $148 this year. The premium must be paid to maintain the Part B coverage. It is necessary to use facilities and providers that accept Medicare. Original Medicare may pay approximately 80% of medical bills on items that Medicare covers. Original Medicare will cover some prescription medications under specific circumstances. Original Medicare does not provide a maximum out-of-pocket limit. This means that you are responsible for
whatever Medicare did not cover.
Now let’s address Medicare Advantage. First, in order to enroll in an Advantage Plan you must have Original Medicare, Parts A and B. Many Advantage Plans include Part D, prescription drug coverage. Plans may offer dental, vision, hearing, fitness, transportation, over-the counter supplies, and many more benefits. The benefits vary by plan.
Advantage Plans come in two flavors. The HMO requires you to use their net work of doctors and facilities. The PPO often allows you to use out-of-network providers but the cost will be higher than staying in-network. Both the HMO and the PPO have a maximum-out-of-pocket limit. The limit may differ from one plan to the next.
There is another option if you want coverage beyond Original Medicare—a Supplement, also known as a Medigap Plan. If you would like to know more about Medigap Plans, call or write. We are happy to answer questions.
We can help you find and enroll in the plan that meets your unique needs.
Lynn Welch Nan Thornton