If you live in Mississippi and you are approaching the age of 65, there’s good news: you will soon be eligible to enroll in Traditional Medicare (Medicare Parts A and B). In order to enroll, you must be 65 or older. Once you are enrolled, you will have access to health care benefits from the federal government. These benefits will cover you should you require a hospital stay, outpatient rehab, or even just a primary care doctor visit. The chart below clarifies which parts of Medicare cover what treatments and procedures.
For many US citizens, Part A is free of charge of your work history is at least 10 years long (or 40 quarters) in total. If you have worked less than that in your lifetime, there are certain fees and premiums you will have to pay before you will have access to Part A benefits. Part B has its own fees and premiums, but they are adjusted according to income, and designed to be as affordable as possible for seniors. Specific amounts can be found here.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Mississippi has a fairly significant population of Medicare beneficiaries within the state – 516,809 to be precise. Of those, a modest 13% (or 67,185 people) prefer to get their benefits and coverage through a Medicare Advantage policy. A slightly larger faction, which makes up almost 24% of beneficiaries (or 122,608 recipients) prefer to supplement their government Medicare benefits with a Medigap policy. We will discuss both Medigap and Medicare Advantage later in this article. The remaining 325,589 Mississippi seniors are either leaving themselves vulnerable to the coverage gaps which plague Traditional Medicare, or they have another form of supplement coverage through an employer.
If you are enrolled in Medicare Parts A and B and worried about your coverage gaps, keep reading. If you are not enrolled in Medicare, click the link for more information on when and how to enroll.
The short answer to that question is: to protect themselves from disastrous, unexpected medical expenses later on in life. As much as the Federal Medicare Program is designed to provide hard-working seniors with comprehensive medical care, there are certain “gaps” in coverage which, at the end of the day, you may be responsible paying for if you don’t have additional coverage. Some of those expenses include:
|Medicare Part A Costs||Medicare Part B Costs|
For a minimal additional expense each month, supplemental coverage (either in the form of a Medigap or a Medicare Advantage policy) can protect you from thousands and thousands in unanticipated medical bills. Many seniors believe that it is a small price to pay for that peace of mind and financial security.
Medicare supplement insurance, also sometimes referred to as a “Medigap” policy, helps you cover the gaps in Traditional Medicare coverage without forcing you to give up any of your current benefits or making you switch networks. The available plans are labeled alphabetically A-N (with the exception of plans E, H, I, and J, which were discontinued as of 2010). The private insurance companies who sell Medigap policies work together with the federal government to make sure that each plan is as comprehensive as possible, while still offering it to seniors like you at an affordable rate. By law, Plan D in Mississippi offers the same benefits as Plan D in Texas or New York. Therefore, you only have to worry about price and provider when you shop around for a supplement.
Below is a Medigap policy comparison chart showing what each plan covers:
[chart category=”supplement” name=”planTypes” state=”MS” zipcode=”39212″]
Another way you can cover the gaps in Original Medicare is to replace your government-sponsored benefits with a Medicare Advantage policy. These are special health insurance policies which are, by law, required to give you the same or more benefits than those available in Medicare Parts A and B. Once you purchase an Advantage policy, the federal government will no longer be responsible for managing your coverage or paying out claims – that responsibility will fall to whichever private company you choose. Some providers even try to offer additional coverage options, like dental, and a small additional price in order to bring in customers.
There is something to be said for having all of your Medicare benefits and additional coverages under a single, simple policy. And, in some markets, Medicare Advantage policies are priced very competitively. But this is mostly due to their restrictive networks. By limiting the number of doctors and hospitals you can go to, the insurance company saves money and (in theory) passes the savings along to their customers. For many seniors, however, taking on an insurance policy with a restrictive network will force them to switch doctors. And that is not a process most people feel comfortable with.
If you do decide to go with a Medicare Advantage plan, you will receive medical care from one of two sources. You will either sign up for a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) plan. Here are some estimates for HMO and PPO plans near you:
[chart category=”advantage” name=”topHMOPlans” zipcode=”39212″ state=”MS”]
[chart category=”advantage” name=”topPPOPlans” zipcode=”39212″ state=”MS”]
Using the helpful chart below, you can easily compare and contrast some of the major differences between these two popular types of coverage. We understand how confusing the choice can be – which is why you need to find as much information as possible on both before you make a final decision. Start by reviewing the information below:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
For your reference, we’ve included a searchable directory on this page. With it, you can find local Medicare offices and get in touch with Medicare experts near you. Feel free to ask them all the questions you want. Their job is to help you get the coverage you need.
[chart category=”general” name=”usefulContacts”]
Helpful Medicare-Related Healthcare Definitions:
HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.
Mon-Fri, 8am-8pm EST