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Grapevine Texas Medicare Plans

Ashford Insurance

Medicare Insurance Made Easy

Grapevine Texas Medicare Plans

Grapevine Medicare

Medicare is the federal health insurance program for older Americans. Eligibility is pretty easy: Everybody can join when they turn 65. What’s not so easy is wrapping your head around Medicare’s dizzying array of rules and deadlines. “Medicare and You,” a guide the government publishes annually.

Medicare provides broad health insurance coverage for U.S. citizens and certain other legal residents of the U.S. who are at least 65 years old. It also provides health insurance for younger individuals who are disabled.

There are four components of Medicare coverage:

  • Medicare Part A: Covers costs when you are hospitalized.
  • Medicare Part B: Helps pay for outpatient doctor appointments, exams, tests, and treatments, plus certain types of medical equipment.
  • Medicare Part C: More commonly known as Medicare Advantage. We’ll get to this in a sec—it’s a bit of a curveball in this alphabetical lineup.
  • Medicare Part D: Covers prescription drug costs.

Like most insurance provided by employers or for individuals through state marketplaces, Medicare enrollees are on the hook for deductibles, coinsurance, and copays. For some services, there are monthly premiums as well.

Every enrollee must choose between one of two different ways to participate in Medicare:

  • Original Medicare. Also known as traditional Medicare, this option includes Medicare Part A and Part B, although it only covers 80% of Medicare Part B costs. Enrollees can cover the 20% coinsurance by purchasing a supplemental Medigap policy from a private insurer. For help covering prescription drug costs, enrollees can choose to purchase a separate Medicare Part D policy.
  • Medicare Advantage. This is also known as Medicare Part C. Medicare Advantage plans are all-in-one programs that cover Part A and Part B, and may also cover prescription drugs. Alternatively, you can purchase a separate Medicare Part D plan. There’s no need—nor are you allowed—to have a Medigap policy if you choose Medicare Advantage.
    Original Medicare vs Medicare Advantage
    The upfront costs of Medicare Advantage are typically lower than Original Medicare, but there are important trade-offs that you need to consider before making the choice between them.

With Original Medicare, the government pays its share of your bills for any doctor that accepts Medicare patients, and you don’t need pre-approval to see specialists. Medicare Advantage works like a health maintenance organization (HMO), in that you are limited to the doctors and facilities that are part of your specific network. This means with a Medicare Advantage plan you may find yourself in a situation where a specialist you need 10 years down the line isn’t covered by your plan. Meanwhile, you’d have been able to see them with no problem with Original Medicare. Medicare Advantage plans also typically require you to get preapproval for doctor appointments and treatment. With Original Medicare, there is no preapproval required.

While it’s technically true that someone in Medicare Advantage can always change their mind and enroll in Original Medicare later on, from a practical standpoint it’s often impossible to obtain a supplemental Medigap policy, which makes switching cost-prohibitive.

What about Medigap?

If you choose Original Medicare, you can purchase a Medigap policy without any medical review during your initial enrollment window and your premium will not be based on any pre-existing conditions.

If you start with Medicare Advantage and want to switch to Original Medicare after the first year, your medical history will be used to determine your eligibility and pricing for a Medigap policy—that means your pre-existing conditions will likely dictate the price you pay, assuming you find a policy that will cover you. Even then, insurers have the right not to cover your pre-existing condition for six months.

Certain states, like Connecticut, Maine, Massachusetts, and New York, offer some protections for people with pre-existing conditions who want to purchase a Medigap policy when switching over to Original Medicare. But for all others, switching to Original Medicare later may be all but impossible.

“When you are 65 and healthy, Medicare Advantage can look appealing, but we encourage people to think about their needs when they are 75 and 85,” says Giardini-Russell. That’s why her firm recommends Original Medicare for clients who can afford the Medigap premium costs.