5 tips for using Medicare
- Add your prescriptions to help you better compare health and drug plans in your area.
- View your Original Medicare claims as soon as they're processed.
- Print a copy of your official Medicare card.
- Review a list of preventive services you're eligible to get in Original Medicare.
- Learn about your Medicare premiums, and pay them online if you get a...
Full Answer
How do I choose the best Medicare Advantage plan?
Here are some tips on how best to make this decision: If you're in a Medicare Advantage plan, shop around. Compare the networks of doctors and hospitals in the plans in your area. Check out the list of prescription drugs that are covered. Consider using an insurance broker or agent, but be smart about it.
Where can I go to see a doctor with Medicare?
You can go to any doctor, health care provider, hospital, or facility that is enrolled in Medicare and accepting new Medicare patients. Are prescriptions covered in Original Medicare? With a few exceptions, most prescriptions aren't covered in Original Medicare. You can add drug coverage by joining a . Do I need to choose a primary care doctor? .
How do I start my first year with Medicare?
Get your free "Welcome to Medicare" visit – Schedule this free preventive visit with your doctor during your first year with Medicare. You’ll talk with your doctor about your medical history, your health needs, and preventive services that may be right for you. Print this checklist [PDF, 142 KB] to help you make the most of your new coverage.
Is Original Medicare enough for You?
There are certainly people who contend that even though Original Medicare has no cap on out-of-pocket costs, it is still plenty of coverage – and for the average enrollee, that’s probably true. But the purpose of insurance is to protect us against significant losses.
What benefits come with original Medicare?
Original Medicare covers most medically necessary services and supplies in hospitals, doctors' offices, and other health care facilities. Original Medicare doesn't cover some benefits like eye exams, most dental care, and routine exams.
What is one of the main differences between Original Medicare and Medicare Advantage?
Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).
How do I get the best out of Medicare?
Image source: Getty Images.Shop around each and every year. Original Medicare, which consists of Part A (hospital insurance) and Part B (outpatient services) is pretty straightforward. ... Consider a Medicare Advantage plan. ... Consider buying supplemental insurance if you have a chronic illness. ... Enroll on time.
What does Original Medicare include?
Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.
What percent of seniors choose Medicare Advantage?
A team of economists who analyzed Medicare Advantage plan selections found that only about 10 percent of seniors chose the optimal Medicare Advantage plan. People were overspending by more than $1,000 per year on average, and more than 10 percent of people were overspending by more than $2,000 per year!
What will Medicare not pay for?
Generally, Original Medicare does not cover dental work and routine vision or hearing care. Original Medicare won't pay for routine dental care, visits, cleanings, fillings dentures or most tooth extractions. The same holds true for routine vision checks. Eyeglasses and contact lenses aren't generally covered.
Is it necessary to have supplemental insurance with Medicare?
For many low-income Medicare beneficiaries, there's no need for private supplemental coverage. Only 19% of Original Medicare beneficiaries have no supplemental coverage. Supplemental coverage can help prevent major expenses.
Why do I need Medicare Part C?
Medicare Part C provides more coverage for everyday healthcare including prescription drug coverage with some plans when combined with Part D. A Medicare Advantage prescription drug (MAPD) plan is when a Part C and Part D plan are combined. Medicare Part D only covers prescription drugs.
Does Original Medicare automatically include Part D?
Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Medicare drug plan (Part D). To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
Does Original Medicare cover prescriptions?
Original Medicare only offers two types of coverage: hospital insurance and medical insurance. If you want additional coverage, you'll need to purchase Medicare Part D for prescription drug coverage and Medigap for supplemental coverage.
What's the difference between traditional and original Medicare?
Traditional Medicare has no out-of-pocket maximum or cap on what you may spend on health care. With traditional Medicare, you will have to purchase Part D drug coverage and a Medigap plan separately (if you choose to purchase one). Costs in MA plans vary.
Can I get my health care from any doctor, other health care provider, or hospital?
In most cases, yes. You can go to any doctor, health care provider, hospital, or facility that is enrolled in Medicare and accepting new Medicare patients.
Are prescriptions covered in Original Medicare?
With a few exceptions, most prescriptions aren't covered in Original Medicare. You can add drug coverage by joining a
Do I need to choose a primary care doctor?
No, in Original Medicare you don't need to choose a primary care doctor The doctor you see first for most health problems. They make sure you get the care you need to keep you healthy. They also may talk with other doctors and health care providers about your care and refer you to them.
Should I get a supplemental policy?
You may already have employer or union coverage that may pay costs that Original Medicare doesn't. If not, you may want to buy a Medicare Supplement Insurance (Medigap) policy.
What is Part A (Hospital Insurance)?
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
What is Part B (Medical Insurance)?
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Mind the calendar
The first and most important step is enrolling on time. Miss that deadline and it'll cost you — potentially for the rest of your life. Your Initial Enrollment Period (IEP) is the time you MUST sign up to avoid hassles. It spans seven months —from three months before you turn 65 until three months after.
Choose doctors carefully
You have a doctor who has taken care of you for many years and you want to keep seeing her. You've just retired to a new community and need a physician. You're satisfied with your current provider but would be open to change.
Avoid surprise bills
Nothing stings like getting medical bills for services you thought were covered by Medicare or your supplemental insurance. Here's how to avoid that ... and what to do if it still happens.
Know your rights
If Medicare denies a claim, you can appeal. And there are people who can help you. Casey Schwartz, a senior counsel at the Medicare Rights Center, says if you're on Medicare and want to appeal a claims decision, you can call the center's hotline at 800-333-4114.
Keep good records
Most of us know to carry a list of our prescriptions with us to show to a new doctor or in case we wind up in the emergency room. But to take your use of Medicare to the next level, experts suggest you keep a running diary of your medical history – from any chronic conditions you have to what medical procedures or tests you've had.
Be open to change
You may be perfectly happy with your current Medicare benefits. You like your Medicare Advantage (MA) plan. Or you're in Original Medicare because you like the freedom of seeing whatever doctor you want. You haven't had any problems with your Part D prescription drug plan. Doesn't matter.
Medicare Part B coverage
Medicare Part B covers medically necessary services such as doctor visits and preventive care. It also covers ambulance services, durable medical equipment, and outpatient mental health services.
Medicare Part C coverage
Medicare Part C (Medicare Advantage) is optional insurance that is available for Medicare beneficiaries who have parts A and B. Part C plans legally must cover at least as much as original Medicare, as well as extras like vision, dental, and prescription drugs.
Medicare Part D coverage
Medicare Part D covers prescription medications. It is voluntary but beneficiaries are strongly urged to get some type of prescription drug coverage. If you decide you want a Medicare Advantage Part C plan, you do not need Part D.
Medigap coverage
Medigap (Medicare supplemental insurance) is designed to pay for some of the gaps in original Medicare. It is not actually a part of Medicare. Rather, it is composed of 10 plans that you may be able to choose from (note that one plan, Plan F, has two versions). These plans vary in terms of availability, cost, and coverage.
Medicare Part A costs
Most people who are eligible for Medicare are also eligible for premium-free Part A. You will most likely be eligible for premium-free Part A if:
Medicare Part B costs
In 2022, there is an annual deductible for Medicare Part B of $233. The monthly premium typically costs $170.10, which is what most people pay.
How much do Part C, Part D, and Medigap cost?
Medicare Part C, Part D, and Medigap all have varying costs based on your county, ZIP code, and the plan provider you choose.
Medicare Advantage
You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.
Medicare Advantage
Out-of-pocket costs vary – plans may have different out-of-pocket costs for certain services.
Medicare Advantage
Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams.
When Original Medicare might be sufficient
For many low-income Medicare beneficiaries, there’s no need for private supplemental coverage. Almost one in five Medicare beneficiaries are dual eligible for both Medicare and Medicaid.
Preventing major expenses
There are certainly people who contend that even though Original Medicare has no cap on out-of-pocket costs, it is still plenty of coverage – and for the average enrollee, that’s probably true. But the purpose of insurance is to protect us against significant losses.
Feeling lucky?
If you never get seriously ill, and if you only ever need the occasional generic prescription, you’ll be fine with Original Medicare alone. But who among us can accurately predict whether or not a catastrophic medical condition will befall us at some point in the future?
Going to the doctor
Under original Medicare, you can choose any providers — primary care doctors and specialists — who accept Medicare. You don't need referrals to see any medical provider and you don't have to worry about your doctor leaving a plan's network. According to the Kaiser Family Foundation, 93 percent of primary physicians participate in Medicare.
Covered care
While Medicare will cover most of your medical needs, there are some things the program typically doesn't pay for -— like cosmetic surgery or routine dental, vision and hearing care. But there are also differences between what services you get help paying for.
Costs
Under original Medicare, the federal government sets the premiums, deductibles and coinsurance amounts for Part A (hospitalizations) and Part B (physician and outpatient services). For example, under Part B, beneficiaries are responsible for 20 percent of a doctor visit or lab test bill.
Logistics
Under original Medicare, to get the full array of services you will likely have to enroll in four separate elements: Part A; Part B; a Part D prescription drug program; and a supplemental or Medigap policy. Physicians and hospitals have to file claims for each service with Medicare that you'll have to review.
Where you live
Under original Medicare, you can access care anywhere in the United States as long as the provider accepts Medicare.
The Pros and Cons of Each Plan
Tanya Feke, MD, is a board-certified family physician, patient advocate and best-selling author of "Medicare Essentials: A Physician Insider Explains the Fine Print."
How They Differ
Original Medicare refers to Part A and Part B, the parts of Medicare that were first established by the Social Security Amendments of 1965. It is often thought of as traditional Medicare. The program is run by the federal government as opposed to private insurance companies.
Pros of Original Medicare
More than 59 million people were on Medicare in 2018. Forty million of those beneficiaries chose Original Medicare for their healthcare needs. 2
Pros of Medicare Advantage
Nearly 20 million Americans, one-third of all Medicare beneficiaries, were enrolled in a Medicare Advantage plan in 2018. 2
Making a Choice
Don't think that you are off the hook for paying Part B premiums just because you are on Medicare Advantage. You will keep paying Part B premiums and you may also pay a monthly premium for your Medicare Advantage plan, although some plans are premium-free.
What is Original Medicare?
Original Medicare is health insurance provided by the federal government. It’s available to seniors age 65 and over, and also to younger people who receive Social Security disability payments.
What Does Original Medicare Cover?
Original Medicare is actually very comprehensive coverage. In addition to medically necessary services to diagnose and treat illness, injuries, and diseases, Medicare also pays for screening tests and preventive care.
Costs with Original Medicare
Although Medicare offers great insurance coverage, it still doesn’t cover 100% of your healthcare costs, and it isn’t free. While most people get premium-free Part A, everyone pays the Part B premium ($144.60 in 2020).
How to Sign up for Original Medicare
If you’re getting Social Security or Railroad Retirement Board benefits, you’ll be automatically enrolled in Original Medicare when you turn 65. Your coverage is effective on the first day of your birthday month.
