JC
Well-Known Member
I have been dealing in Medicare for many years and the #1 thing I hear from beneficiaries is that they are just flat out confused about how medicare works. For this I have come up with a very simple to understand explanation. Please understand this is a very dumb down version to help you understand the basics.
***Because of the complexity of medicare this information is to be used as a starting bases to select plan options. The final option you choose may work slightly different then how I am explaining it. But the fundamentals will be the same.****
To start with we are going to talk about your Part A and Part B of medicare and what costs you are responsible for if that is the only insurance coverage you have.
Part A of Medicare is your inpatient hospitalization coverage. With this, if you are admitted to the hospital, the first thing you will pay is a $1288 deductible (this is a 2016 deductible) This is not an annual deductible, you could be required to pay this multiple times a year depending on how often you are admitted to the hospital. If your hospital stay is longer then 60 days you could be required to pay anywhere from $300-$600+ a day after that.
Part B of Medicare is your outpatient medical coverage. This is for anything such as Dr visits, testing, out patient surgeries. With this you will have a $166 deductible per year (this is a 2016 deductible) and then you are responsible to pay 20% of all of your medical costs. There is no cap to Medicare, so you will pay 20% it makes no difference how high medical bills get.
This is your medicare A and B. Now Medicare gives you 2 options to help control those costs.
First option is what is called a Medicare Supplement or Medigap program. That's just 2 names for the exact same thing. Kind of like saying car or automobile. A Medicare Supplement is a secondary program that you purchase, you pay the monthly premium for it, and then it pays all the costs I just went over. So it pays your hospital deductibles, your medical deductibles, your per day copays, the 20%.....everything that gets billed under your Part A and Part B of Medicare. This type of program never comes with prescription drug coverage so you will have to get your drug plan set up separately.
Second option is what is called Medicare part C or Medicare Advantage. Again 2 names for the exact same thing. This program is more similar to what most people are used to with regular insurance or their employer coverages. This is going to combine all of your parts of medicare into 1 plan. So it covers your Drs, hospitals, and prescriptions.
With this type of program you typically use the insurance companies network of Drs and hospitals and you will pay copays when you go see your Dr. Because these programs are subsidized by Medicare they can be very inexpensive or have no monthly premium at all. These programs can also include aditional benefits such as Dental, Vision, Hearing, Transportation, Over the counter items, Gym Memberships...ect ect.
So it boils down to what you prefer.....Do you prefer a plan where you pay a higher monthly premium and then have no out of pocket expenses? Or do you prefer a plan with little to no monthly cost and then just pay copays as you go?
***Now you may qualify for other options such as Medicaid for low income or Retirement programs through employers. You would need to talk personally to understand how these programs could work with your Medicare plans.***
***Because of the complexity of medicare this information is to be used as a starting bases to select plan options. The final option you choose may work slightly different then how I am explaining it. But the fundamentals will be the same.****
To start with we are going to talk about your Part A and Part B of medicare and what costs you are responsible for if that is the only insurance coverage you have.
Part A of Medicare is your inpatient hospitalization coverage. With this, if you are admitted to the hospital, the first thing you will pay is a $1288 deductible (this is a 2016 deductible) This is not an annual deductible, you could be required to pay this multiple times a year depending on how often you are admitted to the hospital. If your hospital stay is longer then 60 days you could be required to pay anywhere from $300-$600+ a day after that.
Part B of Medicare is your outpatient medical coverage. This is for anything such as Dr visits, testing, out patient surgeries. With this you will have a $166 deductible per year (this is a 2016 deductible) and then you are responsible to pay 20% of all of your medical costs. There is no cap to Medicare, so you will pay 20% it makes no difference how high medical bills get.
This is your medicare A and B. Now Medicare gives you 2 options to help control those costs.
First option is what is called a Medicare Supplement or Medigap program. That's just 2 names for the exact same thing. Kind of like saying car or automobile. A Medicare Supplement is a secondary program that you purchase, you pay the monthly premium for it, and then it pays all the costs I just went over. So it pays your hospital deductibles, your medical deductibles, your per day copays, the 20%.....everything that gets billed under your Part A and Part B of Medicare. This type of program never comes with prescription drug coverage so you will have to get your drug plan set up separately.
Second option is what is called Medicare part C or Medicare Advantage. Again 2 names for the exact same thing. This program is more similar to what most people are used to with regular insurance or their employer coverages. This is going to combine all of your parts of medicare into 1 plan. So it covers your Drs, hospitals, and prescriptions.
With this type of program you typically use the insurance companies network of Drs and hospitals and you will pay copays when you go see your Dr. Because these programs are subsidized by Medicare they can be very inexpensive or have no monthly premium at all. These programs can also include aditional benefits such as Dental, Vision, Hearing, Transportation, Over the counter items, Gym Memberships...ect ect.
So it boils down to what you prefer.....Do you prefer a plan where you pay a higher monthly premium and then have no out of pocket expenses? Or do you prefer a plan with little to no monthly cost and then just pay copays as you go?
***Now you may qualify for other options such as Medicaid for low income or Retirement programs through employers. You would need to talk personally to understand how these programs could work with your Medicare plans.***
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