Medicare and Me

After having great health insurance through my employer, I have been unpleasantly surprised by all the limitations in Medicare. If you’re new to this as well, here are some things I’ve learned.

First, you have to decide on Medicare Advantage or Original Medicare with or without a Medigap policy.

Advantage plans replace Medicare – you don’t have to pay for original Medicare. These also are the ones in the news recently. Obamacare took lots of money from them and insurance companies, such as United Healthcare which has the AARP plans, reacted by reducing the number of providers in the plans.

Advantage plans can be great. Some include vision and dental care as well as free health club memberships. They’re either HMO (Health Maintenance Organizations) where you are limited to a few doctors and must have a referral from your primary care physician to see a specialist or PPO (Preferred Provider Organization) where you can use any primary or specialist (no referral needed) within the organization.

The key to Advantage plans is to determine if the doctors you want to use are in the plans and how important it is to you to be able to see a specialist when you want.

Original Medicare only covers 80% of doctor and non-hospital care costs. You’ll either pay the 20% yourself or obtain a Medigap policy. These policies have alpha designations (A through N) and vary by what percentage of costs they cover that aren’t paid for under Medicare.

Another important caveat – if Medicare doesn’t pay for the item, your Medigap policy won’t either. I stress this because I hear people saying, well if Medicare doesn’t pay for it, my supplement will. It won’t.

I don’t know why but there are important services for seniors that Medicare will not cover. These include eye exams for glasses/contact, hearing aids, dentures, and routine foot care. Strange, but true.

The other important point is that original Medicare doesn’t generally cover prescription drugs. You’ll need a Medicare Part D policy for that. Some Advantage plans do include drugs so read the fine print carefully.

The good news is that the Medicare.gov website is excellent. It explains all this and lots more in easy to understand language. It also provides search capability so you can find insurers and cost of health plans in your area. You also can search via the prescription drugs you currently take to see which plans will cover them at the lowest cost.

If you’re new to Medicare, the government website should be first place you visit.