5 medicare factsTrying to unravel all of the red tape with Medicare could take decades, and millions of blogs! At MediGap Advisors, we get questions every day about Medicare and how Medicare works. But I thought I would touch on some key points and make Medicare a little less complicated and a lot easier to understand.
How does the Affordable Care Act (ACA) affect Medicare?
I doubt you’ll notice any obvious changes to your Medicare benefits, but there have been a few Medicare changes. Medicare now covers most preventive screenings including cholesterol screening, mammograms and colonoscopies with no copay. Benefits for mental health have also been increased from 50 percent to 80 percent. If you’re a high-income Medicare beneficiary, however, you’ll be paying higher part B premiums and prescription costs. Learn more about Medicare and the ACA here.
Can I purchase a Medicare supplement plan through the federal exchange (or state marketplace)?
Medicare supplement plans cannot be purchased as part of Obamacare and will remain privatized without subsidies. Medicare beneficiaries are ineligible to make purchases through the federal exchange or state marketplace.
What is the maximum out-of-pocket I would have to pay in any given year with Medicare?
Medicare sets no limit on how high your out-of-pocket expenses can go in a year. To protect you and your family financially, I recommend a Medicare supplement plan. Medicare supplement plans cap your annual out-of-pocket expenses and also pick up most of what Medicare doesn’t cover.
Which is better, Medicare or Medicare Advantage?
Because everyone’s circumstances are different, this isn’t exactly a cut and dried question. Advantage plans combine your Medicare Parts A, B and D benefits and offer zero-dollar or very low premiums. The insured typically pays a copay for services; however, you must choose your providers from a network list. Budget cuts could affect Medicare Advantage reimbursement rates, causing some doctors to drop from these networks.
Original Medicare is widely accepted among providers, and you’re also covered when seeing nonparticipating providers. When coupled with a Medicare supplement plan, you limit your out-of-pocket costs and can save thousands in deductibles and coinsurance. Learn more about Original Medicare and Medicare Advantage plans by reading our special report, “Medicare Made Easy.”
Can I keep my group coverage if I have Medicare?
Medicare will “coordinate benefits” with a group plan. There are several factors that determine who will be the primary payer and who will be the secondary payer; you can learn more about this in our previous blog, “How Medicare and Group Health Insurance Work Together.”
You’ll want to compare your coverage and coverage costs to see if having both Medicare and your group plan makes sense.
I know this only covers a very small amount of Medicare material, but our Personal Advisors are always available to take your questions as well. Our goal is to make Medicare easy to understand and provide you with the necessary tools to make the best decision possible about your health care.
What bothers you about Medicare? Are there any Medicare questions we can answer for you?

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.