New to Medicare? Let’s cover some basics
When you are turning 65 and during other certain periods of the year, you will have the option to change your Medicare coverage. When selecting the Medicare coverage option that you will be using, it is important to consider your healthcare needs, budget, and plan benefits. They are two main ways to get Medicare:
- Original Medicare (Part A & B)
- Medicare Advantage (Part C)
Additional Medicare coverage options are also available in the form of prescription drug coverage (Part D) and Medigap or Supplemental coverage.
Original Medicare
Original medicare is the most basic coverage offering and includes both hospital and medical insurance up to a limit. It does not cover maintenance prescription drugs. Additionally, it requires a 20% coinsurance on provided services. It does allow you to shop for supplement insurance (Medigap) to cover the risk of the 20 percent coinsurance.
If you choose to go with Original Medicare you should consider Part D coverage. Not having drug covered for 63 days will trigger a lifetime premium penalty.
Original Medicare is not networked and can be used anywhere a doctor or hospital accepts Medicare coverage. This is one of the Medicare coverage options where you don’t generally need a referral to see a specialist.
Medicare Advantage
Medicare Advantage plans are Medicare-approved plans from private companies. These plans include Part A, Part B, and usually Part D coverage all in one. Advantage plans offer richer benefits that sometimes include vision, hearing, and dental coverage. These plans are lower cost than Original Medicare, often zero premium, and do not require a coinsurance for routine care.
However, these plans are networked and you will need to only use doctors and providers inside your plan’s network to avoid higher costs. Some plans pay nothing when you use services out of their network.
You generally do need a referral to see a specialist.
Other Options
You may also have over coverage options if you have a chronic health condition or limited income and resources. Get help with costs.
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