What Is the Best Medicare Plan for You? A Guide

Did you know that approximately 26 million Americans enrolled in Medicare Advantage plans during 2021? The options for Medicare plans are constantly expanding and more benefits can sometimes be offered through a private company.  How can you find the best Medicare plan? With so many options on the market, it helps to know what plans cover different medical expenses from inpatient stays to home health services. 

If you have an interest in learning more about the types of Medicare plans available, then keep reading on for more information!

Medicare Plan Options

Medicare plans can be broken down into two main categories – Original Medicare and Medicare Advantage. There are also some subsidiaries such as Medigap and Part D coverage.

Ultimately, the type of plan you choose comes down to what your needs are and what you qualify for. Typically, a person needs to be at least 65 years old or have a qualifying disability. 

There are exceptions to this rule for things like Amyotrophic Lateral Sclerosis (ALS) and end-stage renal disease. If you want to qualify for Medicare A without incurring a premium, then you need to have received Social Security benefits or Railroad Retirement Board benefits for at least four months. 

At that point – the steps for enrolling are easy and simple. You will automatically receive enrollment once you turn 65 for Medicare Part A and B. 

Original Medicare

Original Medicare includes Part A and Part B coverage. Part A covers health service options such as inpatient stays, hospice, and skilled nursing facilities. Typically, if you qualify for Medicare, then you don’t pay a premium for Part A coverage. 

Medicare Part B does require a premium but includes coverage for outpatient visits, tests and measures, and therapy. Technically, both parts play a role in covering your home health services.

What Medicare services fall under home health coverage?

  • Part-time skilled nursing facility
  • Physical therapy
  • Social services
  • Nursing aides

To qualify for coverage, your doctor will send proof to the insurance that you need these services and are unable to leave the home. What about if you need durable medical equipment (DME)?

Many people discharge from the hospital and need a walker, cane, wheelchair, oxygen, or more. Part B helps cover these items when you are at home, and Part A works at covering these items if you stay in a skilled nursing facility. 

Usually, you will accrue 20% of the Medicare-approved amount and then Medicare will cover the rest – keep in mind, it is not an all-encompassing list and there are items that Medicare doesn’t cover. 

Medicare Advantage

Medicare Advantage plans are becoming a more popular option for people who want coverage of Part A and B with a few extra perks. Private companies offer these plans through Medicare’s approval.

They must provide an equal level of coverage to Medicare Part A and Part B parts. Additionally, these plans are usually only offered during certain enrollment periods each year (typically during the end of the year) and require enrollment for the entirety of the year. 

The benefit of these plans is that they also include drug coverage (Part D). Original Medicare does not include the costs of drugs and you either have to purchase Part D or use supplemental insurance. 

Many Medicare Advantage plans also operate under Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans. This places a limit on you seeing a preferred provider or doctor outside of the approved facilities. 

In some cases, there may be a small amount of coverage for seeing a doctor outside of the network, but in most cases – such as an HMO plan – there won’t be any coverage. If you enroll in a Medicare Advantage plan, then chat with your representative first on if your local specialists and primary care doctors are covered. 

The other benefit of these plans is that they offer coverage for other costs like: 

  • Gym memberships
  • Vison
  • Dental 
  • Hearing
  • Transportation

Not all plans are created equally and you can ask about the specifics of each Medicare Advantage plan. However, you cannot use other supplement insurances like Medigap or enroll in other Medicare-approved programs for drug coverage if your insurance already offers it. 

Medigap Plans

Medigap is a supplemental plan that you can enroll in if you have Original Medicare. It can help with costs such as:

  • Copayments
  • Deductibles
  • Coinsurance
  • International coverage (not always)

However, the downside to Medigap plans is that you cannot use the coverage for other expenses like dental, vision, prescription drugs, or gym memberships. This is largely what makes Advantage plans sound appealing to many Americans. 

Additionally, you are still required to meet your deductible on both Part A and Part B.

Skilled Nursing Facilities

Many people wonder about coverage with skilled nursing facilities. Unfortunately, there are two different types of qualifying coverage. The first is a short-term rehabilitation stay. 

Normally, after a patient is discharged from an inpatient medical facility, they need a longer time for rehab before going home. Medicare will pay up to the first 100 days in a skilled nursing facility if you qualify. 

After 100 days, Medicare stops paying – this means that you are responsible for any long-term stays or transitions into a skilled nursing or assisted living facility. Some of these facilities can cost upwards of $10,000 a month. 

If you suspect you or a loved one will need one of these facilities, then make sure you are planning for future costs in a specialized care facility. 

Best Medicare Plan

The best Medicare plan largely depends on what you are looking for. Medicare helps cover the cost of a home health service, inpatient stays, and therapies. If you opt for an Advantage plan, you could receive added benefits like coverage for gym memberships, vision, and dental plans.

Finding the right plan takes careful consideration of your monthly budget and health needs. To stay up-to-date on all the latest news and articles on retirement and insurance coverage, check out our website.