Why Original Medicare Isn’t Enough

CA Medicare Announcement

Original Medicare (Parts A and B) is an invaluable health insurance for senior citizens that millions of Americans rely upon for timely and essential medical treatment. Unfortunately, as beneficial as the program is, too many people are unaware it doesn’t actually pay for all of their health care costs.

For example, Original Medicare doesn’t pay for deductibles, which are the set amount owed by the individual before insurance starts to make payments. Neither does Original Medicare cover the copayments and coinsurances the individual must pay even after insurance coverage kicks into effect. Then there are the treatments and aspects of care that aren’t paid for by Original Medicare at all: eye exams, hearing evaluations, dental care, and routine foot care aren’t covered; neither are alternative medicine treatments such as acupuncture and most chiropractic services. As a result, even with Original Medicare, out-of-pocket costs can become a significant burden.

Fortunately, there are ways to cover the gaps in Original Medicare. Here is a brief review of some of these options:

Medicare Supplemental Insurance, (aka “Medigap”): This is private insurance that will cover Medicare deductibles, coinsurances, and copayments. Medigap plans are secondary to Medicare, meaning they make payments only after Medicare has paid first. Depending on where you live, there are different plan types you can choose from, each with their own set of premiums and benefits.

Medicare Advantage (aka Medicare Part C): Usually HMOs or PPOs, these private plans are alternatives to Original Medicare, and take the primary role in health coverage, meaning they pay before any other coverage does. While Medicare Advantage plans operate under different rules and restrictions, they are designed to provide the same benefits as Original Medicare. Some Medicare Advantage plans even cover services that Original Medicare doesn’t, such as dental, vision, and hearing care. Others provide the same benefits as Original Medicare, but do so at a lower cost to the individual, so long as the plan’s preferred providers and facilities are used.

Medicare Private Drug Plan (aka Medicare Part D): These private insurance plans cover the costs of outpatient prescription drugs not covered by Original Medicare. Different plans cover different drug formularies, so care should be taken when shopping to make sure a plan covers the right medications for the individual.

Employer-Based Coverage: For those who are still working or have a working spouse, and have health insurance through employment, employer insurance will work in conjunction with Original Medicare to cover health care costs. Employer insurance can either be primary or secondary to Original Medicare, depending on the specific plan.

Retiree Insurance: This is a secondary insurance to Original Medicare that some employers offer to retirees and their spouses, to help fill the gaps of Medicare coverage.

Medicaid: For those with limited incomes, Medicaid, the health care program managed at the state level, might be able to assist in paying for costs not covered by Original Medicare.

Medicare Savings Programs: Those who do not qualify for Medicaid may be able to obtain assistance from government programs that can help pay for Part B premiums, and possibly even deductibles and coinsurances.

Even with coverage under Original Medicare, the potential costs of health care can be substantial. However, by understanding the range of options within your means, you can determine the coverage solution that best fits your circumstances and lifestyle. Call 1-800-356-3615 if you’d like to talk with one of our representatives about which plans and programs might be best for you.

 

 

 

Sources:

http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&script_id=212

http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&script_id=43

http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&script_id=44

https://camedicare.com/what-is-not-covered-by-medicare/