Two roads diverged…
I don’t believe Robert Frost was writing about Medicare, but his poem sums up your decision eloquently. The two main paths usually lead to a Medicare Supplement or Medicare Advantage. In either case, it’s important to understand how Original Medicare works.
Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth; Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanted wear; Though as for that the passing there Had worn them really about the same, And both that morning equally lay In leaves no step had trodden black. Oh, I kept the first for another day! Yet knowing how way leads on to way, I doubted if I should ever come back. I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.
Original Medicare includes Part A and Part B
Part A (hospital insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B (medical insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
You will need Medicare Part A and Part B to enroll in a Medicare Supplement or a Medicare Advantage plan.
You could pay the Part A deductible many times a single year.
A benefit period under Part A begins the day you’re admitted to the hospital and ends when you’ve been discharged for at least 60 days. For 2021, the deductible is $1,484. For example, let’s say you’re admitted again after 60 days, you would owe another deductible for the new period. In other words, this scenario could play out many times during a year.
There’s no yearly limit on what you pay out-of-pocket.
Under Original Medicare Part B has no yearly out-of-pocket cap. After your deductible, you will be responsible for 20% of all medical coinsurance charges. In order to cover some out-of-pocket costs, you can use supplemental coverage, either from a Medigap supplement, Medicaid, or employee/union coverage. You may also enroll in a Medicare Advantage plan to limit the out-of-pocket cost.
Original Medicare does not include Part D Prescription Drug Coverage.
Choosing a prescription drug plan now can save you the late enrollment penalty. Part D late enrollment penalty is 1% a month. If your current plan is not considered credible you could end up paying more later on when you enroll.
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THE ORIGINAL MEDICARE PATH
Arkansas Medicare Supplement plans are a good option for traveling beneficiaries.
A Medicare Supplement (Medigap) plan is designed to work alongside Medicare Part A and Part B. These plans are sold by private insurance companies.
Medicare Supplement Insurance has minimum out-of-pocket spending, premiums are consistent from year to year, benefits are guaranteed to stay the same, they cover you the same when traveling out-of-state, and you are free to use any doctor or hospital that accepts Medicare without sacrificing your coverage.
Original Medicare along with a Medicare Supplement and a stand-alone Part D Prescription Drug plan equals comprehensive coverage.
Do you need Part D Prescription Drug Coverage?
If you don’t have credible coverage under another plan, you may want to consider adding a stand-alone Part D Prescription Drug plan. Even if you don’t take medications regularly, the penalty for not having credible coverage is 1% a month. When you enroll later 1% for each month you are not covered with credible drug coverage will be added to your monthly premium. It’s important if you are using union or employee coverage to ask if the drug plan is considered credible drug coverage.
Do you need a Medicare Supplement?
The best time to purchase a Medicare Supplement plan is during your initial enrollment period (IEP). It’s important to consider this option during your IEP, especially if you visit providers often or have pre-existing health conditions. If you purchase a Medicare Supplement plan when you become Medicare eligible, you typically have guaranteed-issue rights to buy a plan. This means that an insurer cannot turn down your application or charge you a higher premium because of your age or health condition.
Most plans don’t limit you to provider networks. Generally, you can use any doctor or hospital that accepts Medicare payment terms, also known as assignments.
Do you plan to travel outside the United States? If you have grand adventures planned, Medigap plans can provide foreign travel emergency health care coverage.
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THE MEDICARE ADVANTAGE PATH
Medicare Advantage plans are an affordable option in Arkansas.
Medicare Advantage is a type of Medicare plan that is offered by private insurance companies. Medicare Advantage plans have low to no premium, and a mandatory out-of-pocket maximum. Most Advantage plans include a drug plan. Many Advantage plans offer extras like dental, vision, hearing, over-the-counter items, and fitness club memberships.
Do you need Part D Prescription Drug Coverage?
Medicare Advantage Prescription Drug (MAPD) plans combine health insurance benefits and prescription drug coverage.
If you choose a Private Fee-for-Service Medicare Advantage (PFFS) plan or a Medical Savings Account (MSA) plan you are allowed to add a stand alone Medicare Part D Prescription Drug plan.
Can I add a Medicare Supplement to a Medicare Advantage plan?
No, Medicare Supplement Insurance can not be added to a Medicare Advantage plan. However, hospital ancillary plans can help cover the out-of-pocket costs incurred during hospital admissions and the claims are paid directly to you.
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