The Basics of Medicare: A Foundation for Seniors

The Basics of MedicarePhoto by Pexels

Just because you’re in your 60s doesn’t mean your healthcare plan has to be set in stone. Medicare may be the main option you have, but that doesn’t mean it’s your only option. When it comes to understanding the different Medicare plans, many older adults feel confused, doubtful or even anxious. Understanding healthcare is already complicated, but for many seniors starting Medicare, it can be downright intimidating.

Are you interested in learning more about Medicare plans but aren’t sure where to start? If the answer is yes, then it’s best to start with the basics. Here are a few tips about plans, enrollment and costs.

What is the difference between A, B, C and D? The Basics of Medicare Plans

Original Medicare, Parts A and B, were introduced in 1965 to help older adults have access to doctor’s visits and hospital care. Over time, it became apparent that coverage wasn’t enough. Fast forward to today where there are supplemental options and alternatives available to all seniors. Supplemental coverage options include:

  • Medicare Advantage: Sometimes called Medicare Part C, these plans are offered by private insurance companies that include Original Medicare plus other benefits, like dental, vision, wellness programs and more. Medicare Advantage plans vary depending on the insurance provider, so you’ll want to thoroughly review available resources before you sign up.

  • Medigap: These plans provide coverage in addition to your Original Medicare. Offered by private insurers, these plans offer a variety of extra coverage, so it’s important you know your wants and needs before you start looking.

  • Medicare Part D: These plans provide optional prescription drug coverage. Seniors who take regular medication may find them more affordable with this coverage

When can I start? Enrollment in a Nutshell

Seniors have three options for enrolling in Medicare — open enrollment, 65th birthday and qualifying event. During Medicare Open Enrollment, which occurs once a year from October 15 to December 7, and Medicare Advantage Open Enrollment, anyone 65 or older can sign up. During the three months surrounding your 65th birthday — the three months before and after — older adults are also able to enroll. The final and less common enrollment window is a “qualifying event,” which is defined as any kind of major life change, like moving to a different state, losing creditable coverage or losing coverage from your retirement package.

How much does it costs? A Simple Breakdown of Payment Terms

The costs you pay for Medicare will vary due to several factors: the type of coverage you want, how much income you made while working and regulations in your state. It’s important to stay updated on the current Medicare plan costs, but also that you understand the different terms associated with paying for your care.

  • Premium: For many people, Medicare Part A has no monthly premium, but others could pay as much as $400 a month. Premiums are the monthly payment you make to your insurance provider to be covered by your plan.

  • Out-of-Pocket: The most you will have to pay in a year for your medical care is dictated by your out-of-pocket maximum. With Medicare Advantage plans, the most you will pay in recent years stayed around $6,500. Once you spend that, your plan covers 100 percent of your costs.

  • Coinsurance: This is the amount you pay in conjunction with Medicare for a healthcare service. For Medicare Part A, in some cases, like the first 60 days of a hospital stay, you have no coinsurance. For Medicare Part B, you cover 20 percent of your medical bill while Medicare pays the remaining 80 percent.

  • Deductible: These costs you will have to pay for yourself before Medicare begins paying for your healthcare expenses. In the recent past, Medicare Parts A and B had an annual deductible of less than $1500.