1 Medicare doesn’t have a family plan
Medicare plans are only individual coverage, not family. This means that spouses each need to have their own Medicare coverage. Additionally, no dependents receive coverage. In the event that your spouse is younger than you, when you enroll in Medicare they can seek employer coverage or individual coverage through the marketplace (healthcare.gov — the Affordable Care Act website). Note, that if you and your spouse are entering Medicare around the same time, you may be recommended different plans from different companies if they are a better individual fit for you. Some companies to offer household discounts for enrolling with the same company, but other than that it is unique to the individual.
2 There is no cap on out-of-pocket costs in Original Medicare
Most employer plans have annual limits on your out-of-pocket health expenses. Medicare pays 80% of approved medical expenses, then the beneficiary is responsible for the remaining 20%, without a cap. For example, if you have an $100K surgery, you will have to pay $20K, which is why people buy Medicare Supplement plans or Medigap plans to fill this gap.
3 Make a plan for any pending procedures
If your employer plan offers you better benefits than Medicare or costs less, then you may want to have the elective surgery sooner than later. Or wait until you are enrolled in the Medicare system. Surprisingly, the first year for a Medicare beneficiary usually has the highest number of claims because people wait for elective surgery until they are covered on the system.
4 Observation VS Inpatient
Medicare pays different rates according to status. Even if the patient is admitted in a hospital for one week, if they are under “observation” they are considered as out-patients. Medicare requires a three-day hospital inpatient stay minimum before the covering of cost. When a patient is admitted under “observation” , the time frame is not counted toward the Medicare’s requirement regardless of the length.
5 Research can mean more money in your pockets
In the employer health insurance world, you are stuck with the benefits designed for the group. With Medicare, it should be custom to you and your individual needs. Finding an educational resource to learn more about Medicare and how it works, will only help you make smarter decisions when it comes to health insurance. It can also mean saving money in the process.
6 When you enroll into a Medicare Advantage plan, you are disenrolling from Original Medicare
Medicare Advantage plans were introduced in the early 2000’s as an alternative to Original Medicare parts A and B. The way they are marketed is that they offer the same benefits as Original Medicare, but it’s a little more complex than that. While Original Medicare and Medicare Supplement plans are programs regulated by the government, Medicare Advantage plans are controlled by the insurance companies. It literally takes an act of Congress to change Original Medicare, whereas Medicare Advantage plans are in the company’s hands. You essentially give up your Medicare to work with a network provider. Learn more about the difference between Medicare Advantage and Original Medicare with a Supplement here.
7 You can change your Medicare Supplement coverage whenever you want
You don’t have to wait for AEP to change your Medicare Supplement coverage. You can change your Medigap plan anytime during the year, as long as you can pass medical underwriting. The programs that must wait for changes until AEP are Part D Prescription plans and Medicare Advantage plans.
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