If you are reaching Medicare eligibility and have chosen to receive your health care benefits through Original Medicare, you still have some decisions to make.
Original Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.) Original Medicare includes Part A (hospital insurance), which is usually premium-free if you or your spouse paid Medicare taxes while working. If you elect to enroll in Part B (medical insurance), you will pay a monthly premium. (If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.)
Medicare helps cover the costs of many services and supplies, including, but not limited to:
- Lab tests
- Doctor visits
- Supplies (such as wheelchairs and walkers)
- Hospital care
- Skilled nursing facility care
- Nursing care (excluding custodial care alone)
- Hospice services
- Home health services
Original Medicare helps cover the costs of many services and supplies deemed medically necessary by a physician, but these costs may be covered only under certain conditions or in certain settings. There are some services and supplies that are not covered, and unless you have supplemental insurance, those costs would be considered “out-of-pocket costs,” which are health or prescription drug costs that you must pay on your own.
Supplemental insurance can be a wise addition to your Original Medicare coverage. Medicare Supplement (Medigap) Plans are sold by private insurance companies in order to fill the “gaps” in Original Medicare coverage. During a one-time-only, 6-month period, federal law allows you to buy any Medigap policy you want that’s sold in your state. This initial enrollment period starts in the first month that you are covered under Part B and you are age 65 or older. During this period, you can’t be denied a Medigap policy or charged more due to past or present health problems. Some states may have additional open enrollment rights under state law. After this initial enrollment period has ended, you may be turned down or be asked to pay more for a Medigap policy.
Medicare Supplement Plans are standardized, but the costs can vary. For example, all Medigap policies must cover Part A and Part B coinsurance amounts, blood, and additional hospital benefits not covered by Original Medicare, but the same policy sold by two different companies may have differing costs. It is crucial to compare Medigap policies before making your final choice. On-line Medigap comparison sites can make this process easier than ever before, and allow you to review your options clearly and efficiently in order to determine which plan is best for you.