Understanding Medicare

Roughly 68 million people in the US are enrolled in a Medicare plan. If you are one of them, you may have questions about how it works compared to commercial insurance.

It is important to know there are still some expenses Medicare doesn’t pay. For example, for some health care provider visits, you may need to meet a deductible before Medicare pays for your visits. Or, if you’re in the hospital, you will have a deductible to meet, along with daily coinsurance charges after a certain number of days.

These costs can add up quickly, which is why a lot of people get extra health coverage. You have two main options: getting a Medigap policy through a private insurance company or enrolling in a Medicare Advantage plan.

Both help to cover expenses Medicare doesn’t pay. But they work in different ways. Let’s look at each one.

Private Medigap Insurance Policies

Medigap insurance, also called Medicare Supplement Insurance, helps to pay for costs that Original Medicare (Part A and Part B) doesn’t cover. It is sold by private insurance companies, and you need to have both Medicare Part A and Part B to buy a Medigap plan.

Here’s how a Medigap plan works:

Work with Original Medicare: Medigap plans work with Original Medicare (Part A and Part B). So, you have both Original Medicare and Medigap.
Help cover costs Medicare doesn’t pay: Medigap helps to pay for things like copayments, coinsurance, and deductibles Medicare doesn’t cover. For example, if you visit a doctor and Medicare doesn’t pay the full amount, Medigap can help pay the rest.
No network limits: With Medigap, you can see any health care provider or specialist who accepts Medicare. You aren’t restricted to certain in-network providers.
No prescription drug coverage: Medigap policies don’t cover prescription drugs. For prescription drug coverage, you need to purchase a Medicare Part D plan.
Higher premiums: Medigap plans usually cost more than Medicare Advantage plans. You (the patient) pay for this extra insurance out of pocket.

You can buy a Medigap plan from any private insurance company that offers them during your Medigap Open Enrollment Period. Your open enrollment begins when you turn 65 and are enrolled in Medicare Part B and it ends in six months.

During this time, you can apply for Medigap plans and insurance companies can’t deny you coverage for pre-existing medical conditions or charge you higher rates.

Medicare Advantage

Unlike a Medigap plan that works with Original Medicare (Part A and Part B), Medicare Advantage plans replace Medicare. They provide all of the benefits of Original Medicare. Plus, they often include extra coverage like dental, vision, hearing, and sometimes prescription drugs.

Here’s how a Medicare Advantage plan works:

All-in-one plan: Medicare Advantage plans combine hospital (Part A) and medical (Part B) coverage into one plan, often with added benefits like dental and vision care.
Managed care: Most Medicare Advantage plans with a network of health care providers and hospitals. You normally need to use in-network providers and hospitals, unless in certain emergency or urgent care situations.
Extra benefits: Many Medicare Advantage plans offer extra services like wellness programs, gym memberships, and discounts on health-related items.
Value-based care: Medicare Advantage plans often focus on preventive care to keep you healthier. They encourage you to get regular check-ups to find and treat any health issues as quickly as possible, helping you to stay healthy longer.
Cost-sharing: Medicare Advantage plans will usually charge you lower monthly premiums than a Medigap plan. But you will pay out-of-pocket costs like copayments, coinsurance, and deductibles when you get care.

You can buy a Medicare Advantage plan through any private insurance company that offers them. You can compare plans and choose the one that fits your needs during the Medicare Annual Enrollment Period, from October 15 to December 7 each year.

Get Your Annual Wellness Visits

Whether you’re enrolled in Original Medicare or a Medicare Advantage plan, it’s important to get your $0 copay annual wellness visits. These visits are different from a regular physical exam because they are designed to focus on preventive care and help you manage your overall health.

During an annual wellness visit, you and your health care provider will review your overall medical history, health, and conditions, as well as:

Talk to you about preventive screenings and immunizations.
Discuss your health goals and any changes to your lifestyle that could improve your well-being.
Provide a mental health assessment to help screen for any issues like depression or anxiety.
Discuss advance care planning with you to help you make decisions about the kind of medical care you would want if you were to become seriously ill or aren’t able to speak for yourself.

Innovista Medical Center providers can conduct annual wellness visits for beneficiaries of qualified Medicare plans. If you have any questions about your coverage or would like to schedule an annual wellness visit, call us at 866-325-0301.