When it comes to Medicare and health insurance, smart decisions today often lead to long-term financial security tomorrow. The majority of Medicare recipients purchase some form of supplemental coverage. Why? Most seniors know that once they turn 65, they’re eligible for Medicare Part A and Part B. Why would anyone need more coverage? Health insurance can be complicated and taking a few minutes now to understand which services are covered by Original Medicare, which are not, and how supplemental coverage works will help you make an informed decision.  

Original Medicare Has Limitations

Original Medicare is a government-funded program designed to provide basic health care needs for seniors age 65 and older. Part A (hospital insurance) is free for most people, as long as they paid taxes throughout their working life. Part B (medical insurance) is not free. The monthly premium in 2023 for most seniors is $164.90, deducted from your Social Security benefits. Part A and Part B together create Original Medicare. Part C (Medicare Advantage) and Part D (prescription drug benefits) are not considered part of Original Medicare but are offered through private insurance carriers approved by Medicare.

Part A and Part B cover a substantial amount, but they do not cover all of the medical services you could need. Eye care, dental procedures, and prescription drug benefits are not included as part of Original Medicare. In addition, even after paying a monthly premium for Part B, you are responsible for paying deductibles, copays, and coinsurance. For this reason, many seniors choose to add to or ‘supplement’ Medicare coverage with additional benefits. There are three ways to add to Original Medicare: Medicare Supplement (also called Medigap), Medicare Advantage, or prescription drug coverage.

Understand Your Options—Medicare Supplement, Medicare Advantage and Prescription Benefits

Medicare Supplement Insurance Many seniors choose to purchase Medicare Supplement insurance as a way to add to their Medicare benefits. The easiest way to understand Medigap coverage is to think about what it offers. Medigap plans were created to help seniors shoulder the costs of Medicare—the copays, deductibles, and coinsurance costs mentioned above. Even as a Medicare recipient, when you visit your doctor, you will be expected to pay money upfront to meet your deductible, or satisfy a copay. Out-of-pocket expenses can be steep, and the more care you need, the more you will pay.

Medicare Supplement plans are sold through private insurers, as a way to supplement Medicare benefits. To make it easy for seniors, the government created ten standardized plans, named after the letters of the alphabet (A-N). Standardized means that every plan of the same letter, a plan “K” or plan “A” for instance, must include the same exact benefits, regardless of which company sells it. Companies can charge different amounts for plans—and they do. Seniors in the market for supplement insurance are urged to compare plans closely for differences in price, and how benefits are delivered and received.

Medicare Advantage and Prescription Drug Coverage Some seniors choose to purchase Part C, or Medicare Advantage (MA) as a way to add to Original Medicare coverage. With a Part C plan, you still receive your Part A and Part B benefits, but you also add new benefits through your MA plan. Plans vary significantly between companies, as do cost, delivery, and networks. However, unlike a Medigap plan, MA plans do not cover deductibles, copays, or coinsurance costs. Medicare Advantage adds new benefits, like vision and dental care, and even prescription drug benefits.

Part D, prescription drug coverage can be purchased as a stand-alone plan to add to Original Medicare. If you purchase a Part D plan, you will continue to pay a monthly premium for Part B, and also for Part D. Most Medicare Advantage plans include coverage for prescription drug benefits, and seniors looking for an all-in-one plan often turn to MA for Part A, Part Band Part D coverage in one. Note, it is illegal for companies to sell you a Medicare supplement plan and a Medicare Advantage plan.

Deciding If You Need Supplemental Coverage

How do you decide if you need to add supplemental coverage to Medicare? Which additional coverage should you choose? Health insurance choices are personal, and what’s right for one person may not be for another. Think about your financial situation and your health. Remember that your healthcare needs may change as you age. Multiple hospital visits, ongoing doctor appointments, and more can potentially cost thousands of dollars in deductibles and copays. On the other hand, if you stay relatively healthy into your senior years and avoid the doctor, you may not incur high out-of-pocket costs. While no one can predict the future, supplementing Medicare insurance is a practical choice, which may eliminate the need to deplete savings should a major medical condition occur.

It is important to note that Medicare Supplement insurance cannot be purchased with a Medicare Advantage plan—it is one or the other. If you are considering adding to your Medicare coverage, decide if it is more valuable for you to have help paying out-of-pocket costs or extra benefits to visit the dentist, or eye doctor or get coverage for prescriptions.

References:

https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html

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