If you are around the age of 65, then you are probably in the process of enrolling in Medicare if you aren’t receiving benefits already. Medicare Parts A and B are what make up the base of Traditional Medicare benefits. The chart below outlines exactly what sort of benefits Medicare recipients can expect, from hospital care to outpatient treatment. But there are some treatments which aren’t covered – referred to as “coverage gaps” – that could end up costing a lot of money if you don’t take the proper precautions.
Medicare costs start out with Medicare Part B. There are low-cost monthly premiums required of every beneficiary, as well as deductibles which you can calculate on this website. Part A, however, is a little bit different. For many seniors, Part A is free. However, if you have a short employment history, you will be required to pay a deductible for access to Part A benefits. Anything shorter than 10 years or 40 quarters will put you in the category of mandatory deductibles for Medicare Part A.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
More than half a million seniors – 625,924 to be precise – are currently taking advantage of the Medicare benefits program. Of those, 61% either aren’t protecting against their coverage gaps with supplemental insurance, or they are covered by some sort of employer program. Of the remainder, the most popular solution is a Medigap insurance policy. 23% of seniors in Oklahoma have one, for a total of 144,292 beneficiaries. The less popular option, Medicare Advantage makes up 16% of all beneficiaries, or 100,148 people.
Seniors approaching the age of 65 should be enrolled in Medicare, or at least starting the process. If you need help with Medicare enrollment, click the link provided.
In short, no. There is certainly no legal requirement for it, anyway. But you should keep in mind the coverage gaps we’ve talked about so far. The chart below describes only some of the out-of-pocket expenses you might be footing the bill for if you suffer a medical emergency and are covered by nothing other than Original Medicare benefits:
|Medicare Part A Costs||Medicare Part B Costs|
But there are ways to protect yourself. As discussed earlier, Medicare Advantage and Medigap supplement insurance are two of the most popular means by which seniors insure themselves against coverage gaps. We’ll discuss each option further in this article, and give you the information you need to make a choice between the two.
More often than not, these are referred to as Medigap policies. When you purchase a Medigap policy, you choose between one of ten available plans (outlined below) from a private health insurance company. If you suffer a medical emergency, and Medicare is incapable of covering your expenses, then the benefits from your Medigap policy will kick in and help make up the difference. For the sake of convenience, each plan offers the same benefits, regardless of where you live. Therefore, the only variables that will change from state to state are the provider, and the overall price of the policy.
[chart category=”supplement” name=”planTypes” state=”OK” zipcode=”73505″]
Medicare Advantage gets a little more complicated. Also known as Medicare Part C, an Advantage policy is an alternative to Traditional Medicare offered by a private health insurance company who is legally required to offer you the exact same benefits as your original Medicare policy, if not better. Sometimes, this “better” coverage comes in the form of a dental plan or prescription drug coverage. And many Medicare Advantage customers are happy with the simplicity of managing all their medical benefits under one single policy.
There are some negative aspects of Medicare Advantage, however. For starters, your network of doctors and physicians will be limited in order for your insurance company to keep their costs down. If you are thinking about switching to an Advantage policy, keep in mind that being forced to switch to an in-network doctor is a very real possibility. This might be an easier switch for some to make than others.
With Medicare Advantage, doctors and facilities must be a part of their Health Maintenance or Preferred Provider Organization (HMO and PPO, respectively) in order to receive care. Otherwise, you could be paying out-of-pocket.
[chart category=”advantage” name=”topHMOPlans” zipcode=”73505″ state=”OK”]
[chart category=”advantage” name=”topPPOPlans” zipcode=”73505″ state=”OK”]
Below is a table of the most frequently asked questions with regard to these two policies, and the informative answers that you and seniors like you need to know:
|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.|
Additional Resources and Information for Oklahoma Seniors
Still have questions? That’s actually a good thing. The more information you have at your disposal, the easier it will be to make the right decision about your health care needs. We’ve included this directory of contact information for local Medicare insurance offices in your area. By contacting and talking to experts in the Medicare field, you’ll be empowering yourself to make the right choice.
[chart category=”general” name=”usefulContacts”]
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