Turning 65 and excited about Medicare, but feeling overwhelmed by all the options? We understand! This article will simplify things by focusing on Original Medicare and Medicare Advantage. We’ll explore what each covers, how they differ, and what to consider when making your choice. Our goal? To help you pick the Medicare plan that best fits your needs and keeps you healthy and happy in your golden years!
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1. Original Medicare vs. Advantage Costs
Turning 65 shouldn’t mean your wallet takes a beating! Here’s one really important thing about Medicare: The costs can differ a lot depending on which option you choose and when you enroll. Here’s what you need to know about the money side of things:
- Premiums: This is the monthly fee you might have to pay for your plan. Original Medicare Part B has a premium ($174.70 in 2024), and most Medicare Advantage plans have premiums too (which cost around $18.50 on average, in addition to the Part B premium).
- Deductibles: This is the amount you have to pay for covered services before Medicare or your plan starts paying. Think of it like a down payment. Original Medicare has deductibles for some things, and some Medicare Advantage plans have deductibles too.
- Copays: This is a fixed amount you might have to pay for a doctor’s visit or prescription drugs. It’s like a mini down payment. Original Medicare doesn’t usually have copays, but some Medicare Advantage plans do.
- Out-of-pocket limits: This is the most you would have to pay for covered services in a year. Original Medicare doesn’t have an out-of-pocket limit, but some Medicare Advantage plans do.
- Penalties: If you don’t enroll in Part B when you’re first eligible (your initial enrollment period) and you delay enrollment because you have health insurance from your employer or union, there’s usually no penalty. But, if you don’t have other health insurance and delay enrollment in Part B, you will likely have to pay a late enrollment penalty for as long as you have Part B.
- This is a permanent increase in your monthly Part B premium for each 12-month period you delayed enrollment after your initial enrollment period.
- The exact amount of the increase depends on how long you delayed enrollment, but it can be significant. For example, if you delayed enrollment for two years (24 months), you could pay a 20% penalty on your Part B premium for the rest of your life.
- There’s generally no late enrollment penalty for Medicare Advantage. However, you can only enroll in or switch Medicare Advantage plans during the Open Enrollment Period (October 15 – December 7) each year. If you miss the Open Enrollment Period, you might have to wait until the next one unless you qualify for a Special Enrollment Period due to certain life events.
So, how do you compare all these costs?
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- Use the Medicare Plan Finder tool. It can help you compare different plans and see their premiums, deductibles, copays, and out-of-pocket limits.
- Call Medicare at 1-800-MEDICARE (1-800-633-4227). They can answer your questions and help you compare plans.
2. What’s Covered? It’s Not Always the Same!
Original Medicare and Medicare Advantage are both great options, but they don’t always cover exactly the same things. And honestly, it can be like comparing apples and oranges. Here’s what you need to know about coverage:
- Original Medicare: This covers a lot, but it might not cover everything. Think of it as the basic package. You might still have to pay for some things out of your pocket, like copays and deductibles. You’ll also typically need a separate plan to cover your medications (like Medicare Part D).
- Medicare Advantage: These plans are like special all-inclusive packages. They usually cover everything Original Medicare covers, plus some extras like vision, hearing, or dental care. But, there can be a catch – you might need to see only doctors who are in the plan’s network.
3. Who Can You See?
Remember how we mentioned Medicare Advantage plans are like all-in-one packages? Well, here’s something else to keep in mind – these plans often have a network of doctors and hospitals that agree to work with the plan. Here’s why that matters:
- Seeing doctors in the network: If you choose a Medicare Advantage plan, you’ll usually get the best coverage and fewest out-of-pocket costs by seeing doctors in the plan’s network.
- Going outside the network: If you see a doctor or go to a hospital outside the network, it might cost you more. The plan might not cover it as much, or you might have to pay the whole bill yourself.
Do you have a favorite doctor you see all the time? Make sure they are in the network of any Medicare Advantage plan you’re considering.
4. Prescription Drug Coverage
Both Original Medicare and Medicare Advantage can help with your medications, but how they do it can be different. Here’s how:
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- Original Medicare: This doesn’t usually cover your prescriptions by itself. You might need to buy a separate Medicare Part D plan to help pay for your medications.
- Medicare Advantage: Many Medicare Advantage plans already include prescription drug coverage (like Part D). But, each Advantage plan has a list of covered medications called a “formulary.”
Here’s what you need to know about formularies:
- Formulary: This is a fancy word for a list of medications covered by your plan.
- Formulary changes: These lists can change every year, so a medication covered this year might not be covered next year.
- Costs: The price you pay for your medications can vary depending on the plan’s formulary and whether the drug is on a lower tier (cheaper) or a higher tier (more expensive).
5. Flexibility vs. Restrictions
Original Medicare and Medicare Advantage offer different levels of freedom when it comes to choosing your healthcare providers. Here are some things to consider when thinking about flexibility:
- Do you have a favorite doctor you see all the time? If so, make sure they are in the network of any Medicare Advantage plan you’re considering.
- Do you like to travel or do you see specialists? Original Medicare might be a good choice if you need more flexibility.
- Do you want a plan with clear costs and predictable monthly bills? A Medicare Advantage plan might be a good option.
There’s really no right or wrong answer. The best plan depends on your individual needs and preferences. Consider how much flexibility you need and weigh it against the coverage and costs of each option.
6. Additional Benefits
Original Medicare is great, but some Medicare Advantage plans offer even more. These extras can be really helpful depending on your needs. Here are some examples of bonus features you might find with some Medicare Advantage plans:
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- Vision care: This can help cover things like eye exams, glasses, or contacts.
- Hearing aids: Some plans offer discounts or even help pay for hearing aids.
- Dental care: This might cover cleanings, fillings, or even dentures.
- Fitness programs: Some plans offer gym memberships or discounts on fitness classes.
BUT…
- Not all plans offer these extras. It depends on the specific plan you choose.
- There might be extra costs. Some plans might charge more for a plan with additional benefits.
7. Enrollment Periods
There are specific times when you can enroll in Medicare or change plans. Think of them like special shopping days, but for your healthcare! Here’s what to know about enrollment periods:
- Initial Enrollment Period (IEP): This is your first chance to sign up for Medicare. It starts 3 months before you turn 65 and lasts for 7 months, including the month you turn 65 and 3 months after. This is the best time to enroll to avoid any late enrollment penalties.
- Open Enrollment: This happens every year from October 15th to December 7th. During this time, you can switch between Medicare Advantage plans or switch back to Original Medicare.
- Special Enrollment Periods (SEP): These are times outside the normal enrollment periods when you might be able to change plans due to certain life events, like losing your employer coverage or moving to a new area.
Choosing Between Medicare and Medicare Advantage
Phew! That was a lot of info, but you’re almost there! Here’s a quick refresher on the 7 sneaky secrets we talked about to help you choose the BEST Medicare plan for you:
- Secret #1: Money Matters! Compare costs like premiums, deductibles, and copays for both Original Medicare and Medicare Advantage plans.
- Secret #2: What’s Covered? It’s Not Always the Same! Original Medicare covers a lot, but you might need a separate plan for prescriptions. Medicare Advantage plans often include extras like vision or dental, but have networks of doctors you might need to see.
- Secret #3: Who Can You See? With Medicare Advantage, you usually need to see doctors in the plan’s network for the best coverage and the fewest out-of-pocket costs.
- Secret #4: Prescription Drugs. Original Medicare might need a separate Part D plan for prescriptions. Medicare Advantage plans often include prescription coverage, but check the plan’s formulary (list of covered drugs) to see if yours are included.
- Secret #5: Flexibility or Fences? Original Medicare offers more freedom to choose any doctor, but there might be more rules about coverage and costs. Medicare Advantage plans have networks and might have set costs, but less freedom to choose doctors.
- Secret #6: Bonus Features! Some Medicare Advantage plans offer extras like vision, hearing, or dental care. These are great if you need them, but not all plans offer them, and might cost extra.
- Secret #7: Timing is Everything! Choosing the Right Enrollment Period! There are specific times to enroll or change plans. The Initial Enrollment Period (IEP) is your first chance to sign up for Medicare to avoid penalties. Open Enrollment happens every year in October and December.
Now you’re equipped with these secrets, you can make a well-informed decision about your Medicare plan! Don’t hesitate to call Medicare at 1-800-MEDICARE (1-800-633-4227) or talk to a counselor for help (like Toni King!).
