PA Resources Ensure Residents Are Getting the Right Medicare Coverage

By James Donaldson

Selecting the right health insurance after you turn 65 can feel stressful and daunting, especially if you don’t know what to look for in a coverage plan. Luckily, there are plenty of online tools and local resources out there that can help eliminate stress and cater your plan to your specific needs.

Finding the right care plan can save you hundreds or thousands of dollars each year, as well as determine the quality of care you receive. So when it comes time to plan for Medicare coverage after 65, keep a few things in mind and you’ll have everything you need to get started.

Health factors to consider:

  • Your medical needs: When deciding on Medicare and supplemental health insurance, be sure to make a decision based on your specific medical needs. If you have a medical condition or need monthly prescriptions, you’ll want to take that into account to ensure that your plan covers those costs, as well as unexpected illnesses and injuries.
  • Your current options: Did you know you could be eligible for extended benefits after retirement? Depending on your work history and your previous employer-provided insurance, you may be able to enroll in COBRA coverage. In addition to the federal COBRA plan, Pennsylvania also offers mini COBRA coverage for businesses with fewer than 20 employees. If, instead, you plan to work past the age of 65, talk with your employer to find out if your plan will continue or if you need to enroll in Medicare.
  • Coverage cost: Like any health insurance plan, when you enroll in Medicare, you’ll also have to consider how much your plan will cost each month. The cost of original Medicare is fairly consistent across the board, but there are supplemental coverage options you’ll want to look into that have different premiums. As you prepare to leave the workforce, keep Medicare in mind while calculating your retirement budget.

Medicare information to know:

Unlike employer-provided plans, Medicare is an individual enrollment system, which means you won’t be able to cover your spouse or your family under your plan. This also means you’ll need to choose a plan based on your personal healthcare needs. Before making your selection, make sure you know what options are out there.

Parts A and B are also known as original Medicare. Part A covers hospital stays and is free to most people who enroll in Medicare. Part B covers outpatient hospital procedures, regular office visits and lab work. Part B often comes with an additional monthly premium, depending on a few factors, like your income. Each part of original Medicare comes with its own copay and deductible as well.

Part C, sometimes referred to as Medicare Advantage plans, provide alternate methods of receiving health care benefits. Part C came to be after legislators wanted to give people over 65 the option to choose their providers, similar to plans offered by private insurance providers, like health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Medicare Advantage plans cover Part A and Part B services and are offered by private providers approved by Medicare, each with their own set premiums, copays and deductibles. Some opt for Part C because it is a single stop for all your needs – even vision and dental at times – often at a lower cost. However, there are also financial consequences to acquiring medical services outside of your provider network with Part C, so it’s important to do your research.

Additional coverage options:

Part D can be added to your plan for an additional premium, and it covers prescription drugs at an affordable rate. Most opt for Part D as soon as they’re eligible for enrollment, as there are fees that you’ll have to pay if you decide to enroll later on. Part D plans vary from year to year, so make sure you talk to your health insurance agent every enrollment period to re-evaluate your coverage.

Medigap is the most common form of supplemental insurance for Medicare. But what is supplemental insurance? Essentially, Medigap is paired with Parts A and B and covers the expenses that original Medicare doesn’t, such as copayments, coinsurance and deductibles. This prevents you from spending too much out of pocket in a pinch. There are 11 Medigap plans offered by health insurance companies, each slightly different in what they cover and what they cost.

Other gaps in coverage, such as the deductible you will have to meet after Part A has covered 60 days in the hospital, or the 20 percent copay for doctor visits that isn’t covered by Part B, may still require a solution. There are government assistance programs available in every state to fill in these gaps, including Medicaid and Medicare Savings Programs.

Finding Local Resources:

Once you learn the basics of Medicare and the various supplemental health care options, you’ll be in good shape to start talking about which plan would work best for your circumstances. There are also local resources available to help you make the right decision:

  • Pennsylvania’s State Health Insurance Assistance Program, APPRISE, is a free health insurance counseling service available to PA residents. APPRISE provides digestible information about Medicare, Medicare Supplemental Insurance, Medicaid and Long-Term Care Insurance. You can contact a representative at 1-800-783-7067.
  • Pennsylvania Department of Aging provides news, resources, legislative updates and informative articles for older adults and their caretakers. The department also has an online Area Agency on Aging Locator, which can connect you with programs and services specific to your county.
  • Local agencies are also available for health insurance consultations. These agents can help you find an initial plan and help you reassess your plan every year.

No matter which route you take, the most important thing to consider is that every person is different and these resources are available to help reduce your stress when making a selection. Ask questions, do your research and take your time finding the choice that best suits your needs.

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