Choosing a Medicare Coverage Plan

Choosing a Medicare Coverage Plan from North Carolina Lifestyle Blogger Adventures of Frugal Mom

Most seniors 65 or older, along with younger individuals with qualifying medical conditions, are eligible for coverage under Medicare. However, this government-administered medical health plan includes several options. For many individuals, Medicare Advantage plans represent the best option for obtaining coverage that suits their lifestyles at an affordable price.

Traditional Medicare versus Medicare Advantage Plans

Traditional Medicare consists of Part A, hospital insurance, and Part B, medical insurance. Under traditional Medicare, individuals may consult with any medical provider that accepts Medicare patients without obtaining a referral. Part A carries no premiums. For 2020, premiums for Part B start at $144.60 per month, with higher premiums for individuals with higher incomes. Both Part A and Part B generally carry deductibles and require co-pays.

Traditional Medicare does NOT cover the cost of prescription drugs. Instead, individuals have the option to obtain prescription drug coverage under Part D, which requires a separate premium with costs that vary by plan. Finally, supplemental coverage, often called Medigap insurance, covers some of the expenses traditional Medicare does not cover, such as dental, vision, or hearing care.

Medicare Advantage plans, also known as Part C, include Part A and Part B coverage. However, plans are administered by private insurance companies approved by Medicare as either HMO or PPO coverage. Medicare Advantage plans usually require a separate premium and Part B costs. Anthem’s Medicare Advantage plans are a cost-effective option with excellent coverage at a low cost.

Medicare Advantage Pros and Cons

Medicare Advantage plans have several significant advantages over traditional Medicare. First, many Medicare Advantage plans also include prescription drug coverage, eliminating the need for a separate Part D plan. Second, although some Medicare Advantage plans carry an additional monthly premium, for many individuals, out-of-pocket costs are lower than traditional Medicare because of lower deductibles and co-pays. Finally, Medicare Advantage plans frequently cover costs that traditional Medicare does not provide, including dental, vision, hearing, adult day care, home health care, or home modifications that facilitate aging in place, such as wheelchair ramps.

However, Medicare Advantage plans require individuals to seek care within prescribed networks or pay higher out-of-network costs. Referrals may also be required. In addition, individuals who opt for Medicare Advantage plans cannot also obtain Medigap insurance.

Medicare Open Enrollment and Disenrollment

Open enrollment for Medicare runs from October 15 through December 7 each year. Individuals with traditional Part A and Part B Medicare plans may choose a new Part D plan. During Open Enrollment, individuals may also transition from traditional Medicare to Part C — or Part C back to traditional Medicare coverage. As of 2019, individuals enrolled in Part C also have an extended “disenrollment period” from January 1 to March 31, during which they can change to a new Part C plan or revert to traditional Medicare and choose a Part D plan if they desire.

Getting the Right Medicare Plan at the Right Price

There is no “one size fits all” Medicare plan — the right plan depends on several factors, including specific medical conditions that individuals may have. However, for many individuals, Medicare Advantage plans represent the best value for money. Part C plans often include prescription drug coverage, which is not included in traditional Medicare. In addition, Medicare Advantage plans often provide additional services, such as dental, vision, and hearing care, and cover the costs of home modifications such as wheelchair ramps.

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