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Medicare can be a confusing topic. From figuring out Part A, B and D coverage to understanding what is and isn't covered, it can be easy to feel a bit overwhelmed when it's time to sign up for coverage or adjust your coverage during open enrollment. These easy tips can help you get the most out of Medicare while avoiding unnecessary health expenses.

Don't Assume There Is a Cap on Out-of-Pocket Costs

With a typical employer medical insurance plan, you will have an annual limit on your out-of-pocket costs. Original Medicare pays 80% of covered medical expenses, but there is no cap on what you may pay. With a Medigap or Medicare Advantage policy, you will have a safeguard that caps the maximum you will pay.

Medicare supplement or Medigap plans are private health plans that cover all or most of the out-of-pocket costs of original Medicare. When Medicare pays your claims, they will be automatically sent to your Medigap plan for payment. Medigap does not cover prescription drugs, however. Medicare Advantage plans do include Part D prescription coverage. With this option, you keep paying the Part B premium as usual with an extra premium. This plan has copays and deductibles, but there is an out-of-pocket limit. If you have original Medicare, you can switch to Medicare Advantage during open enrollment.

Consider Delaying Medicare Part B Sign-Up

You are eligible to sign up for Medicare coverage during a seven-month window beginning three months before your 65th birthday. If you do not sign up during your first enrollment period, your Part B premiums will increase by 10% for every one-year delay. If you continue to work after 65 and have covered through a group plan, you will need to sign up for Medicare within eight months of leaving your job or ending this coverage to avoid a penalty. It may be worthwhile to delay signing up for Part B coverage if you have health coverage through an employer.

Medicare Doesn't Cover Everything

Medicare is an important form of coverage for seniors that provides many types of free preventative care plus coverage for chronic conditions, hospital stays and many types of doctor and medical services. Still, it doesn't cover everything. Understanding your gaps in coverage can help you plan for supplemental medical insurance.

One of the most common misconceptions about Medicare is that it covers nursing home care or long-term care. Medicare only covers nursing home care when it's medically necessary for skilled nursing care. Medicare generally won't cover long-term care in a nursing home or home health care. A supplemental long-term care insurance policy may be a good option if you are concerned about paying the cost of long-term care, which refers to help with activities of daily living like dressing, bathing and eating.

An insurance agent can help you best utilize your Medicare benefits. Contact us today to learn more.


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