The answers to these questions can help you choose the Medicare coverage that may best fit your needs.
Frequent doctor visits can get costly, depending on your coverage.
With Original Medicare, you pay 20% of the Medicare-approved amount The amount Medicare determines to be reasonable for a covered service. Providers who “accept assignment” agree to accept this amount as payment in full. Providers who accept Medicare but not assignment can charge up to 15% above this amount. for most doctor services after you meet the Part B deductible.
- With most Medicare Advantage plans, you pay a small copayment for each visit after you meet the Part B deductible.
- With either type of coverage, you also pay a monthly Part B premium to Medicare.
The 2013 Part B deductible is $147. The 2013 Part B monthly premium is $104.90 for most people.
Many Medicare Advantage plans contract with a network of providers and pharmacies to get special pricing. Plan members pay less out-of-pocket for care and services they receive from network providers. If your preferred provider or pharmacy is not in the network, you may pay more for the same care and services. With Original Medicare, you can use any provider or pharmacy in the country.
Chronic conditions may require regular health care with frequent visits to doctors or specialists. You’ll want to look at your coverage choices carefully to make sure the care you need is covered at a cost you can live with. Sometimes a Medicare Advantage Special Needs Plan can be a good fit in this kind of situation.
People with ESRD generally can’t enroll in a Medicare Advantage plan and must stay with Original Medicare.
A change in your health status could mean that you will require more care and services in the future. It’s a good idea to estimate what kinds of care and services you may need and how often you may need them. This information will help you compare how well different Medicare coverage choices may work for you. Your doctor may be able to help you with this.
Most prescription drug plans and Medicare Advantage plans that include drug coverage have a formulary. If your drugs are not on your plan’s formulary A list of the prescription drugs that are covered by a specific Medicare Part D plan. , you may have to pay more. You want to make sure you find a plan that covers the drugs you take. Sometimes a plan will cover a similar medication that you can substitute.
Many people who have employer or union health insurance enroll in Medicare Part A and refuse Part B. Part A is premium free for most people and will cover hospital expenses as secondary insurance. Part B charges a premium, which you can avoid paying until you need the coverage—without penalty as long as you qualify for a Special Enrollment Period. Also, you can delay getting prescription drug coverage without penalty if you have creditable coverage Prescription drug coverage from a health plan other than a Medicare Part D standalone plan or a Medicare Advantage plan that includes prescription drug coverage and that meets certain Medicare standards. through another source.
It’s important to talk to your plan administrator about how your plan may work with Medicare before you make any decisions. You may have more options than the usual ones.
Many Medicare Advantage plans contract with a network of providers and pharmacies within a geographic service area In Medicare Advantage, the area in which a plan offers service. A service area is typically a county, state or region. to get special pricing. Plan members pay less out-of-pocket for care and services they receive from network providers. You may pay more if you need services while travelling. Original Medicare provides coverage nationwide.
Medicare limits the number of days it will cover for care in a nursing home. You’ll need to figure out whether your care will be covered under different plan choices, for how long and at what price.
It’s important to understand your out-of-pocket health care costs so you can compare what you’re paying now with what you might pay with a different plan.
Some doctors do not accept assignment Term used to indicate a doctor’s agreement to take the Medicare-approved amount paid for a service as full payment. If your doctor accepts assignment, your share is limited to your coinsurance payment, usually 20% of the Medicare-approved amount. and may charge more than Medicare allows for some services. The additional cost is referred to as excess charges. Doctors who do not accept assignment may bill you for excess charges.