Do you live in Utah? Are you 65 years of age or older? If so, you might already be enrolled in the federal Medicare Program. The base plan of this program, which includes Medicare Part A and Medicare Part B, covers most of your health care needs, from hospital stays to regular doctor visits and more. As long as you are 65 years of age and a legal US resident, you can qualify to enroll and receive benefits.
In theory, the Medicare program was designed to provide health care benefits for retired persons who would be living on a fixed income. For this reason, the program tries to be as affordable as possible while still being financially solvent enough to provide health care for retired citizens. Part B premiums and deductibles, which can be calculated here, are required of every beneficiary. And if you have worked fewer than 10 years (or 40 quarters) in your lifetime, you may be required to pay a deductible for Part A as well.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
In total, there are more than 299,427 Medicare beneficiaries in the state of Utah. Of those, 34% (or 101,805 people) are supplementing their Traditional Medicare coverage gaps with a Medicare Advantage policy. And additional 14% (or 42,323 retired persons) instead are supplementing their coverage gaps with a Medigap policy. In large part, though, 52% of Medicare enrollees are either relying upon some sort of employer benefit program, or they aren’t supplementing their coverage at all – which could cost them down the road.
Are you currently enrolled in Medicare? Are you unsure? Do you need more information on the Medicare enrollment process? Because you must first be enrolled and receiving benefits in order to supplement Parts A & B.
Generally, Medicare Parts A and B are designed to be fairly comprehensive. Unfortunately, there are gaps in this coverage which, if not supplemented, can leave you with some disastrous out-of-pocket expenses. Younger and healthier retired persons may not have to worry about large medical bills now. However, if you require frequent hospital stays or if you anticipate a downturn in your health in the near future, here are some of the expenses you can expect from Original Medicare:
|Medicare Part A Costs||Medicare Part B Costs|
Supplement policies help put your mind at ease in the event of a sudden health emergency. There are two very popular forms of coverage available to the public right now: Medicare Advantage, and Medigap policies. This article will help you learn the basics of each supplement so that you can make an intelligent decision about your health care needs.
In Utah, you have the option to add a small, supplemental health insurance policy to your existing Medicare benefits. This policy will be underwritten by a private company, while the federal government will still be in charge of your Traditional Medicare benefits. Plans E, H, I, and J are no longer available as of 2010, but plans A, B, C, D, F, G, K, L, M, and N are available for you to choose from based on your individual needs. Each plan is the same in all 50 states, meaning that Plan K offers you the same coverage whether you live in Utah or Ohio. They will likely differ by price and provider from state to state, though. Each plan provides the following benefits:
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$79||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$109||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$70||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$95||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$79||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$98||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$53||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$63||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$47||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$110||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
If you would like to switch from receiving government Medicare to receiving identical Medicare coverage and benefits from a private health insurance company, then you might want to consider a Medicare Advantage policy. Federal law requires these policies to provide “equal or greater” benefits when compared with Traditional Medicare so that you don’t put yourself at too much of a disadvantage by relying on a private company to help manage your health care needs. Sometimes, Medicare Advantage policies offer extra benefits, like vision or dental, for a minimally higher cost.
One of the ways in which Medicare Advantage policy costs are kept low is via restricted networks. The companies are picky about which doctors and physicians they choose to allow into their HMO (Health Maintenance Organization and PPO (Preferred Provider Organization) networks, so the doctor you may be seeing now might not be available to you if you switch to a Medicare Advantage plan. This is an important factor to keep in mind if you are thinking about purchasing such a policy.
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$348||AARP MedicareComplete Essential (HMO)||Health Only||$29.00||$0|
|$348||AARP MedicareComplete (HMO)||Health and Drug||$29.00||$0|
|$0||Humana Gold Plus H2486-003 (HMO)||Health and Drug||$0.00||$0|
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$0||HumanaChoice H4606-006 (PPO)||Health Only||$0.00||$0|
|$552||HumanaChoice H4606-001 (PPO)||Health and Drug||$46.00||$310|
|$876||Regence MedAdvantage Basic (PPO)||Health Only||$73.00||$0|
There are many fine differences between either form of supplemental coverage. For some people, a Medigap policy might be the perfect solution for their specific needs. For others, it’s possible that Medicare Advantage might give them just enough coverage to get by. It’s important to know the differences between the two, as outlined 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.|
Everyone has their own unique situation, and this short article alone cannot clear up every single possible question you might have. For this reason, we have included some helpful resources for you. By using the contact information at the bottom of this page, you can get in touch with experts near you who can clear up any confusion you may have regarding Medicare, your benefits, and how best to supplement your existing coverage:
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