Your Medicare Advisor

Which Parts of Medicare Do I Really Need?

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Dear AMAC,

I am turning sixty-five in the next few months and trying to prepare myself for this new transition to Medicare. I still work part-time, but I will not have other insurance when I go on Medicare. I know there are different parts to Medicare, but which ones do I really need?

-Stanley (Grand Rapids, MI)

Hello Stanley,

Thank you for taking the time to write us. Since you will not have any other insurance once you become eligible for Medicare, the first step you may want to take is to sign up for Original Medicare by contacting the Social Security Administration. You can do this as soon as 3 months before your 65th birthday, and your coverage will start on the first of your 65th birth month. E.g., if your birthday is August 20th, your Original Medicare will start August 1st. If your birthday falls on the 1st of the month, Medicare will start a month prior.

Original Medicare consists of two parts- Part A and Part B.

Part A is inpatient hospital coverage, and it covers:

  • Semi-private rooms
  • Meals
  • General nursing
  • Drugs as part of your inpatient treatment
  • Other hospital services and supplies as part of your inpatient treatment

Part B will cover outpatient medical services such as:

  • Medically necessary services: Services or supplies needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is most likely to work best.

Now, what will Original Medicare cost for you? Part A is premium-free for most people. But Part B does have a standard monthly premium of $170.10, per person, in 2022.

Both Parts A and B have deductibles, as well as copays, and coinsurances that you will be responsible for as you use the coverage. Keep in mind there is no annual out of pocket limit with Original Medicare. Therefore, if you just take Medicare Part A and B with no additional coverage, you could face significant out of pocket costs. If you choose not to take them at all, you could face penalties later down the road if you change your mind.

Although you paid into Medicare while you were working, that does not mean that Medicare will cover everything. This is a common misconception. In fact, Original Medicare was never intended to be a sole coverage for all your healthcare needs. If you choose to pick up additional coverage, you do have some options to help offset your out-of-pocket medical expenses.

After picking up Original Medicare, most people enroll into either a Medicare Advantage (Part C) plan or a Medicare Supplement (Medigap).

Medicare Advantage plans replace Original Medicare Parts A and B. Even though you will remain enrolled in Part A and B, you will only use the Medicare Advantage insurance when you receive medical care.

Advantage plans operate off a network like an HMO, PFFS or PPO. These plans can cover hospital, medical, and prescription drug coverage (Part D) under one plan. They typically have a lower monthly premium, but you will be responsible for copays, coinsurance, and deductibles that will have an annual cap called a Maximum Out of Pocket. This is a limit on how much you pay for medical services in a year. Some Advantage plans offer benefits for dental and vision, but they vary from plan to plan.

Medicare Supplements work with your Original Medicare Parts A and B to fill in the gaps for what Medicare doesn’t cover. Supplement plans do not have a network, so you may use these plans at any provider throughout the country that accepts Original Medicare. These plans cover hospital and medical services, and you may enroll into a separate stand-alone drug plan if you need prescription coverage (Part D). The Supplements usually have a higher monthly premium, but you may have much less out of pocket expenses with a Supplement.

Regardless of which option you choose, you will still have to pay your Part B premium, which again is $170.10 a month for most people. Parts A, B, and D may have penalties if you don’t enroll in them when you are first eligible. Although you are not required to pick up a Medicare Supplement plan or Medicare Advantage plan, they can help ease your share of healthcare expenses that A and B will not cover. So, going back to your initial question on what you “need,” I’d say it really depends on what’s important to you.

Sincerely,

Your Medicare Advisor

If you wish to speak to one of our licensed Medicare advisors on specific pricing and plan details, please give us a call at 855-611-4856. We would be more than happy to assist you.


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Faith
20 days ago

Don’t pay… Don’t pay… Don’t payIf they refuse to “resubmit” with the right codes then they are out of luck getting YOUR money back. There’s is a tremendous amount of healthcare fraud being disguised as “billing errors”.I was billed for procedures the hospital E. R NEVER performed. They billed for IVs and pain medications I never received because I had rejected it since I began feeling better while I was waiting. Since I am so aware of healthcare fraud(been there before) when Admissions brought me papers to sign I documented that I refused narcotics, IVs and Oxygen…. I initialed signed and requested a copy of all of it. Hospital did not like my making a notation like that and asked me why. I said “Don’t take it personal, but most hospitals are crooks that is one of the major reason why we have such inflated medical bills in America. They like to double bill and bill for services (procedures) not rendered”Reply from Nurse:”Well we don’t do that”1 month later: I get my Insurance statement outlining the procedures they never performed and insurance paid it minus $800 that I was responsible for. I contacted the hospital twice and they agreed to remove charges but didn’t. Third time they wanted to negotiate a “reduced amount” after I had shown them a copy of my paperwork with my notation. And I said that I had a better idea, I would be reporting them for billing fraud, Insurance fraud to the state etc. And that I was not paying. They were apologetic but said that if I don’t pay they would report non payment to the credit agencies and I laughed. “Go ahead, I will just show them evidence of your fraudulent charges and have it removed. Then I will go to the courthouse near my home and file a lawsuit after consulting with my attorney. I have all the time in the world and filing with the Clerk will only cost me ~$15.00 and Constable serving you papers about $20.00Now if you guys don’t show up the Court it’s an automatic judgement against the Hospital. If your Lawyers do show up, how much is that going to cost you? I’m betting a lot more than $800.00″The lady then said, O. K. I need to pass this on to the ” Legal Department” Never heard from them again and never saw charges on my credit report. That happened about 6 years ago. Way past the statute of limitations to collect in my state. If you don’t know how to fight charges… Get yourself a Healthcare Billing Advocate.

Old Silk
13 days ago
Reply to  Faith

That is an arm of the medical industrial complex. I have not used it so far, but 11 years ago when I was taking care of my mother at my home I could not believe the charges for services and products never provided when her Medicare statement came. I did not bother to even try to talk to the providers but called Medicare and reported the fraud. They dealt with it too, because nurses and the business office called about it. I told them that the only thing there was to discuss was that they charged for products and services that they knew they did not provide. Their only reply was that Medicare paid for it, not my mother. I told them that fraud was fraud. A neighbor once received a statement that Medicare had paid for his autopsy. He had to iron that mess out.

Harvey
23 days ago

What options in Medicare do I have as a federal retiree who has carried health insurance into retirement?

Tina
10 days ago
Reply to  Harvey

You should not be penalized: If you have employer insurance (maybe any insurance?) past your retirement (or ss disability). there is a form from SSA (Form L564)that you fill out.Then employer fills their part out and returns to you. You submit to Medicare and choose your Medicare plan(s) or can do straight Medicare.

Rebecca
23 days ago

If you do not take part D from the start you will be penalized for the rest of your life one you start taking it. That is for prescription coverage.

Jocie Taylor
23 days ago

Let him know that medigap does not cover I care dental none of those other ones that advantage will cover

Sid
23 days ago

Good information, thanks

Gabe
23 days ago

I am on Medicare. In March of this year I went for my annual physical. Internet physician advised me that at my age I should do the PSA and Hep-C, which I agreed. The billing dept. at lab and provider group put in the wrong CPT codes (billed as routine not diagnostic) and hence Medicare refused to cover the tests and I had to pay out of pocket. Medicare told me that the provider or lab can resubmit the bill with the right codes and they will approve it, but they refuse to change it. I did file an appeal with Medicare and waiting answers. What should I do to prevent this in future. Medicare allows for these tests to be done annuals and will pay for it.

Windy
23 days ago
Reply to  Gabe

First mistake…don’t EVER PAY when you shouldn’t. Call the lab and have them resubmit because that’s what Medicare is going to require. Next time get all information from mcr and make sure your doctors and labs follow your request.

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