Medicare can be confusing, so learn all you can

By Nick Moriello
Posted 9/23/21

No matter what age you are, experts say it’s never too soon to start planning for your retirement. And there is a lot to think about, including taking care of your health, so that you can enjoy …

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Medicare can be confusing, so learn all you can

Posted

No matter what age you are, experts say it’s never too soon to start planning for your retirement. And there is a lot to think about, including taking care of your health, so that you can enjoy the years to come. A big part of that is having health insurance coverage that helps keep you well and provides peace of mind if you are sick or injured.

One health insurance option for older Americans is Medicare, the federal health insurance program designed for retirees. Most people can enroll when they turn 65, and people under 65 who suffer from certain disabilities and illnesses, like end-stage renal failure, may also qualify for Medicare.

For a lot of us, the “parts” that make up Medicare can be confusing. Here is a basic breakdown: Part A covers hospital stays, follow-up nursing care after a hospital stay, hospice care and some in-home health care. Part B covers things like doctor visits, outpatient hospital services, ambulance services, mental health services, certain therapies, diagnostic services and preventive services. These two parts are often referred to as “original Medicare.” Part C is more commonly referred to as Medicare Advantage, and Part D covers prescriptions.

Part C, or Medicare Advantage plans, is presented by private health insurers, such as Highmark, and typically offers benefits that support members’ total health, such as low-cost access to doctors and preventive care, and covers things like prescription drugs, vision and hearing services, dental care and chiropractic care — benefits you won’t get with original Medicare.

Medicare Advantage plans also include extra services, like help with managing a chronic condition such as diabetes or heart disease and other wellness-related benefits. As health or budgetary needs change, Medicare Advantage members also have the flexibility to change their plan once a year during the annual enrollment period, which runs Oct. 15-Dec. 7. Having Medicare Advantage coverage also protects members from unforeseen costs like hospitalizations, surgery or expensive prescription drugs.

What’s more, with a Medicare Advantage plan, monthly premiums are typically low and premiums for each plan are the same for every person, regardless of age or health history. You also have built-in financial protection, since the plan’s annual out-of-pocket limit helps keep costs under control. Many insurers even offer coverage with $0 monthly premiums. However, folks who see doctors regularly or take medications often may want to consider a Medicare Advantage plan with a low monthly premium that offers more coverage and can save money in the long run. You also want to be sure your Medicare Advantage plan includes a network of reputable providers who are experienced in high-quality care for older adults and have strong ties to the community.

The point is, there are many choices when it comes to Medicare Advantage plans, which means there are options to fit just about everyone’s need.

Even if Medicare Advantage is not right for you, Medigap (or Medicare Supplement) plans offer another option and can help reduce out-of-pocket costs when paired with Medicare parts A and B coverage.

Just as planning and saving for retirement should start at an early age, the more you know about Medicare, the more prepared you will be when you or a loved one — such as a parent or grandparent — are eligible to enroll. To learn more, visit the Medicare website.

Nick Moriello is market president of Highmark Blue Cross Blue Shield Delaware.