5 Things You Need To Know Before Choosing A Medicare Plan

By: Sharon Wagner

Most people think of Medicare as only for seniors, but 16 percent of Medicare recipients are people under 65 with disabilities. This means that anyone with a disability or who has a family member with one should be trying to understand exactly how Medicare works. These are the basic things you need to know if you want to make an informed decision.

What Parts A, B, C, and D Mean

Medicare is divided into four parts: A, B, C, and D:

●      Part A is Hospital Insurance, covering any inpatient hospital care. It is the most basic level of Medicare, offered automatically to all retirees who have paid into the system.

●      Part B is Medical Insurance, covering things like lab work, preventative care, and outpatient services. The vast majority of Medicare recipients pay a premium for Part B.

●      Part C is Medicare Advantage, which is a separate type of coverage, managed through a private insurer. You still pay your Part B premium in addition to any Part C premiums.

●      Part D is Prescription Drug Coverage, which many people add to Parts A and B.

Together, Parts A and B are known as Original Medicare, a term most often used in contrast to Medicare Advantage. You can have Part D either as an add-on to Original Medicare or as part of a Medicare Advantage plan.

What Coverage Do You Need

This depends on your healthcare needs. In a 2016 survey, over 80 percent of Americans over 65 took two or more prescription drugs. This indicates that the vast majority of seniors would benefit from prescription drug coverage. Those in Medicare through disability, however, may or may not need this.

According to The New York Times, about a third of Medicare recipients have Medicare Advantage. You may want to look into it if you need care for vision, dental or similar areas not covered in the basics.

The Difference Between Medicare Advantage And Medigap

There is also something called Medigap, or Medicare Supplemental Insurance. It is (very understandably) often confused with Medicare Advantage.

This is additional private insurance you take out to essentially fill the “gaps” created by your Medicare deductibles. A Medigap policy can reduce the amount you pay on any given claim. Medicare Advantage, as established, is a type of insurance in itself.

How Much Are You Likely To Pay

Part A is free for anyone who has paid 10 years of FICA taxes, which covers most retirees but not most disabled people. Unfortunately, that means that Medicare recipients on disability often have to pay $437 a month in premiums just for Part A.

The standard premium for Part B in 2019 is $135.50 a month - this is the baseline everyone has to pay. For high earners (above $85,001), this will be adjusted on a sliding scale.

The basic premium for Part D is $33.19 a month, but the maximum deductible (i.e: the amount of money you will have to pay before the insurance starts covering the cost) is $415. These costs vary according to the plan.

Part C (Medicare Advantage) plans average $36 a month.

When To Sign Up

There are essentially two ways you can enroll in Medicare: automatically at the age of 65 or through a disability. For the latter, your coverage will usually begin 24 months after you start disability benefits. Then, there’s an annual enrollment period where you can make changes. AARP explains it all in more detail in their enrollment guide.

Navigating Medicare is understandably confusing. There are online resources dedicated to explaining all of this in detail, and which are written specifically with a non-internet-savvy audience in mind: try Medicare.org for simple, clear guides on all things Medicare. If you are a disability recipient, you may want to consult a disability charity or association for advice, as what applies to you may not always be the same advice given to a senior.

(Sharon Wagner can be contacted at sharon.wagner@seniorfriendly.info or Seniorfriendly.info)