Medicare is invaluable, but the system was never intended to provide for all health care. Relying on Medicare alone is like braving a storm with an old, leaky umbrella. Even after you meet Medicare’s Part A and Part B deductibles, you have co-pays and co-insurance charges even for health care that is covered. And, on sunny days when you’re in good health, you may still have to pay for things beyond Medicare’s benefits. Medicare does not cover:
- Routine dental care
- Hearing aids
- Exams for fitting hearing aids
- Most prescriptions (even insulin, unless you use a pump)
- Long-term care
- Cosmetic surgery.
If you’ve been signed up for Medicare for a while, you still have the option to try a Medicare Advantage plan or a Medigap plan to expand your Medicare benefits. Before your coverage for major things like hospitalization starts, you need to meet Medicare’s Part A deductible ($1,156 in 2012). That’s tied to a benefit period, so you may have to meet it more than once a year. For doctor care, unless it’s considered to be recommended preventive care, you have the annual Part B deductible ($140 in 2012). And, you also have 20-percent co-insurance for diagnostic doctor services and treatment. Well, you don’t need a calculator to see where this is going. A Medigap plan would work with Medicare to reimburse you for many of these out-of-pocket expenses. And, you can apply for one of several different Medigap plans throughout the year.
Or, you may find one of several Medicare Advantage plans can actually replace your original Medicare coverage while offering extra benefits. A quarter of those enrolled in Medicare (12.1 million) already have a Medicare Advantage plan. And, until Dec. 7, you can see if an Advantage plan would help you, too. That’s when Medicare’s Annual Enrollment Period ends. Unless you are new to Medicare, this is the only time most Advantage plans are available.
The BIG difference between Medicare and Medicare Advantage plans is that Advantage plans limit your annual out-of-pocket costs. Medicare does not, so you can never be sure how much you’ll have to pay for health care with original Medicare. Maybe, offering the security of being able to plan for health care is the advantage that earned Medicare Advantage plans that name.
Since you may have a dozen or more Advantage plans competing for your business right where you live, Dec. 7 doesn’t give you much time. That’s the end of the 2012 Annual Enrollment Period. Better start checking on what’s available now, so you can make a well-informed decision and save on health care for years to come.
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.