There are currently two ways to become enrolled in Medicare. The first is that you reach the age of 65; the second is if you become disabled. As many who are enrolled in basic Medicare will tell you, there are significant gaps in the coverage. It is important to know what these gaps are and what the available options for coverage are so that you have the coverage that you need.
What Medicare covers is a little spotty. Here are a few things that standard Medicare part A leaves out:
- No dental preventative care
- No benefits for hearing or vision exams
- No coverage outside of the U.S.
- No coverage for nursing care after 100 days
- Only 1 physical exam per year
If you have Medicare Part A and B (which will take care of a few medically necessary procedures), you may need to look at a few other options for your coverage, which will require some money out of pocket.
You have some options for additional coverage: Medicare Advantage Plans (commonly referred to as part C), Prescription Drug Coverage (part D) as well as Medigap insurance (labeled as plans A through N).
If you are a qualified senior over the age of 65 who is looking for a medical plan that encompasses everything, part C can be a great option because you will have a Medicare provider through a standard HMO in most cases. These are usually more affordable, but may cost more for out of pocket expenses throughout the year.
If, however, you don’t like what Medicare covers, Medigap may be an option. The plan that you choose within Medigap will cover different needs, including:
- Basic benefits
- Skilled nursing
- Medicare Part A deductible
- Medicare Part B deductible
- Foreign travel emergency
There are caveats to all of the plans and state regulations, so make sure to study these with a health insurance company or research on the Medicare.gov website to make sure the items most important to you or your loved one will be covered.
If you choose Medigap, Part D for prescription coverage is not included, so you would need to buy that separately. Similarly, if you have a Medicare Advantage Plan, Medigap won’t work, so Medicare and you need to become very fluent with each other.
The best option for any enrollment in Medicare is to choose the plan that works for you sooner rather than later so that you have coverage for all pre-existing conditions.