Making the Most Out of Medicare

“Medicare is complicated!”

I hear this all the time from family members, clients and the general public. The reality is Medicare is only complicated if we don’t know how it works.

Every time I give a presentation on this subject, I begin by taking a poll of the audience to see who has it and who has private insurance. Think it’s strange to begin a presentation on Medicare with a poll about private insurance? I ask this question because the audience usually consists of beneficiaries or adult children with private insurance.

I then ask, “Those of you who have private insurance, how many of you know what your benefits are? What is your deductible? What is your out of pocket cost?” Less than one third of those with private insurance will know the answer to one of these questions, much less all three.

How do all these private insurance questions relate? If an adult child doesn’t know what his or her insurance covers, then beneficiaries who once had insurance but now rely on Medicare certainly won’t know what is covered.

The next question I ask is, “Do you have a Traditional or an Advantage plan (HMO/PPO administered by an insurance company)?” A few more people may know the answer, but not many. Most people don’t understand Advantage plans, and many still think they have a Traditional when they really have an Advantage plan.

Medicare can certainly seem complicated. So how do you make the most out of it?

Know your coverage:

Medicare original contains Part A and Part B

– Part A covers hospitals, skilled nursing facilities and home health.

– Part B pays 80 percent, leaving you with a 20 percent copay/coinsurance.

MediGap/Supplemental policies

– Separate plans purchased to fill in the “gap” of what Medicare does not cover

– You must pay monthly premiums.

– Depending on your plan within the supplemental policy, your plan can cover up to the 20% copay/coinsurance of Part B.

– Retiree coverage varies by company and can be primary coverage (i.e.: Federal Employees).

Advantage Plans (Insurance plans managed by insurance companies with specific networks)

– Can be Health Maintenance Organization/Preferred Provider Organization

– You must use providers within the insurance company’s network.

– Your insurance company sets a deductible, out of pocket costs and copays (they will generally be different than a Traditional plan).

– Some plans have additional coverage like hearing aids, but these coverages vary from plan to plan.

Medication Coverage

– Medication is covered through Part D.

– Medication can also be covered through your Advantage Plan.

Start at the beginning

From the very beginning, figure out your coverage. Without knowing your coverage, using Medicare or Medicare Advantage will be much harder!

Ask questions

Next, ask questions!  Medicare.gov is an easy website to navigate, and the information is written to help you understand your Medicare plan and coverage. If you have a Medicare Advantage, use the website of your insurance company to find the answers to your questions. Other services and advocacy programs are available to help you understand Medicare coverage as well.

You don’t know what you don’t know

Finally, don’t act like you understand it if you don’t! Ask! Ask about things like a yearly wellness checkup that are covered. These tips will go far to ensure you take advantage of all the preventative care offered to keep yourself healthy.

Hopefully this helped simplify things for you! Be sure to also check out this list of 8 Little-Used Medicare Benefits to consider.