Once you reach the mature age of 65, you’re eligible for Medicare. This works in two plans, the Original and the Advantage. Medicare Advantage is more of a bundle of many services at a set price.
Out of all the people in the United States, 17.8% of people are covered by Medicare. People are living longer, which is why we see an increase in those enrolled in this program.
When your employer doesn’t give you a quality retirement health insurance plan, this is an excellent option for you because it’s tailored to the needs of seniors. If you’re approaching 65 and want to know more, check the Medicare Advantage plans on this link, and continue reading.
What’s the Difference
So, what exactly is the difference between the Original Medicare and Medicare Advantage plans? The first is a plan that only includes Part A and B, hospital, and medical care. This is the most basic, and then you can also add Part D, which is prescriptions.
The Original is more affordable with its premiums but doesn’t include all services. This can result in a lot more out of pocket expenses.
A Medicare Advantage plan (also known as Part C) includes all parts and has additional services that aren’t covered in the Original policies.
What’s Included
The Medicare Advantage plan can have Part A, B, and D included. Part A is for all hospital expenses, including nursing home care, hospice, and home health care. Part B is for medical coverage, which includes doctor appointments, prevention services, outpatient care, and medical supplies. Part D covers prescriptions.
Medicare supplement plans or some other plans give supplemental services such as dental, vision, and hearing care. These are essential add ons because as we age, these senses tend to decline. If you’re never had a problem with these in your youth, you could need the care now.
Who Qualifies
First, as mentioned above, you need to be at least 65 years or older to use Medicare. However, young people with disabilities and those with End-Stage Renal Diseases can use Medicare as well.
You can get free Part A coverage under a few circumstances. The first case is when you’re 65 or older and have been paying the Medicare taxes for at least ten years. Another way is that you’re getting benefits from Social Security or the Railroad Retirement Board.
If you or your spouse had a career with a government job that offers Medicare with the retirement plan, then you’ll also receive it.
The Rules
Just like any health insurance plan, Advantage has a set of rules you must follow. The plan can charge for certain out of pocket costs.
You need to understand whether you need a referral to see a specialist or not. Also, you need to know about the difference between regular checkup coverage and emergency. Your provider might charge different things.
The Cost
Each Medicare Advantage plan has its own out of pocket expenses. These plans tend to be lower than the Original Medicare plan.
However, you’ll have to pay a higher monthly premium for an Advantage plan. In addition, it’s possible to owe for copays, deductibles, or when you use an out of network doctor. You’ll have to pay more if you add on the supplemental coverage.
Most plans have a limit on the out of pocket costs you’ll have to pay yearly. This ensures that you can still get proper medical care without spending all of your money.
Enrollment Period
When it’s your first time applying for Medicare Advantage, there’s a short window you need to enroll in. The period is October 15th to December 7th each year. There’s no exception; you need to send in your information during this time.
If something changes, you have from January 1st to February 14th to disenroll your plan for that year. Again, after that date, there’s nothing that can be done.
You should mark these dates on your calendar so you never go unprotected.
The Bottom Line
As you age, your health starts to decline. It’s more important now than ever to have proper health insurance coverage. Medicare is set up to provide support to the elders in our community.
Some key things to know about Medicare Advantage is the difference between this and Original Medicare, what’s included, who qualifies, the rules, the cost, and the enrollment period. Once you understand all of this, you’ll know the key facts.