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Understanding Your Medicare Options

Medicare Enrollment Form

Understanding Medicare can be daunting. It’s an often complicated and convoluted realm, where it’s not always clear what the best decision is. Aside from reading the large manual you get in the mail, how are you supposed to know what’s best for you? And because of how important Medicare is to our general health and well-being as we age, it is important to understand your options. We will try to lay out the basics here.

Medicare Basics

First, it is important to understand Medicare basics. Medicare is available to anyone 65 and older living in the United States. Medicare does not have the “plans” you may be used to from your experience with insurance, it has “parts.” Basic Medicare consists of Part A and Part B. You will enroll in these parts through the Social Security office, so it’s important to keep any mail you receive from that office. Medicare Part A involves your hospital care, while Part B involves your outpatient care. Part C is an optional Medicare Advantage plan, while Part D deals with prescription drugs. You are eligible for Parts A, B, and D on the first day of the month you turn 65.

Confused? Let us lay it out. The base rate for Medicare 2020 is $144.60 per month. For those with a higher income, the cost may be higher. Part A, which covers any hospital or skilled nursing facility stays you may have, is free for the first 60 days, as long as you’ve worked in the last 10 years. After 60 days, the amount Medicare contributes to your stay diminishes. You will be responsible for a hospital copay, which can add up fast. It is one of the reasons people may choose supplemental coverage. The cost of Part B, which covers doctor visits, surgeries, lab tests, and exams, depends on your income. Part B is necessary, especially if Medicare is your primary insurance, and covers 80 percent of your doctor visits and procedures. The average premium for Part D is around $35 per month and also depends on your income. 

There are also supplemental coverages, such as Part C, which are also called Medicare Advantage plans. Advantage plans are actually private insurance plans that help to cover the costs of Medicare. These plans pay instead of Medicare and are optional. If you choose to participate in Part C, you will be able to choose a provider with the lowest copays. There are also Medigap Plans, which help cover the costs of Medicare for low-income individuals. The difference is that when you participate in Part C, you will be paying a copay for services at the time they are rendered. Under Medigap Plans, you would not pay a copay. Medicare Advantage plans usually also roll in Part D coverage, which can be beneficial if your prescriptions are covered. It is worth mentioning that you will not be able to enroll in supplemental coverage without being enrolled in Parts A and B first. 

As mentioned above, it is important to keep mail from the Office of Social Security, as well as the Centers for Medicare & Medicaid Services. This will most likely be information on your plan and important to hang onto. 

When deciding what plan is best for you, it is important to consider a number of factors. For instance, do you travel and need a more expansive network of coverage? Or would a more local option suffice? Can you afford to pay copays if it leads to lower premiums? Which plan will give you the greatest sense of peace of mind? Consider what’s most important to you when deciding how to approach Medicare. 

Consider Meeting with an Elder Law Attorney

Do have questions regarding Medicare, Medicaid, or similar matters? Contact the experienced elder law attorneys at The Mattar Firm today. We will help you to understand the details of Medicare. Call 844-444-4444.


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