Many people who finally reach Medicare age and qualify for both Part A and Part B are likely coming off employer group health insurance. For some this can be a scary transition as one gets quite used to having and knowing which doctors accept their medical insurance and which network they are in.
Throw in the various options that you can get along with, or in replace of, Medicare A and B and it’s no wonder people are so confused. For those obtaining original Medicare, there are a few choices you can make to help assist them in paying their medical bills, and these may either open up or severely limit where they may use their insurance. Deciding on a Medicare Advantage plan or Medigap insurance will depend on one’s own needs and situation.
Medicare Part A and Part B
Medicare Part A covers hospital services, and Part B covers doctor’s services. It’s highly likely and hopeful that you will mostly be using Part B Medicare, and it’s well known that there are expenses, or gaps, that you are responsible for after Medicare pays its approved amounts.
One option is to simply keep just Part A and Part B, and have no other insurance. You can also just have Part A, as many people do until they retire, and enroll in Part B when you need it. This however can be quite costly if you do not enroll in the proper time period as you could be assessed a large penalty and might be delayed coverage.
In the case of just having Part A and Part B, one common question often asked is if there is a network or not. Medicare is a federal program and your insurance can be used nationwide. There is no network, you do not have a primary physician (although you may have your own doctor that you like of course), and you may use your coverage in any state provided the doctor accepts original Medicare.
Medicare Advantage Plan
Some people opt-out of original Medicare in favor of a Medicare Advantage plan that might be offered in their area. These plans have networks, and are either PPO’s, HMO’s, or Private Fee for Service. You do not have the benefits of Part A and Part B once you opt-out and enroll in one of these plans, yet you still must pay the Part B monthly premium. Many people we speak with state that they do not pay anything for their plan, not even the Part B premium. This is absolutely untrue as they forget the premium is being deducted from their Social Security check. Out of sight, out of mind as they say.
As well, with an Advantage plan you do not have the luxury of getting medical coverage if you are outside your network. You will have emergency-only access and any on-going treatment thereafter must take place back in your network. This could cut a vacation trip short in a hurry!
Medigap plans (Medicare supplement insurance) are actually part of the Medicare Federal system. You do not opt-out of Part A and B, because the supplement pays many or most of those gaps and they work together. As stated above, because Medicare itself can be used anywhere in the country, Medigap insurance is also nationwide. And because Medigap plans pay the Medicare coinsurance, copays, as well as deductibles depending on the plan letter, these plans give those who travel the most flexibility with their Medicare insurance. The most important thing to remember when shopping for a Medicare Supplement is that every company has the exact same coverage. Therefore it is extremely important to check rates from all the top companies to make sure you are not overpaying for your coverage.
Using our free website is the easiest way to do that. Simply enter your zip code to get Medicare Supplement quotes right away.
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