How Do You Choose the Right Medicare Plans for Your Parents?

The idea of picking the right Medicare plan for yourself seems simple enough, but what if you had to do it for someone else? Trying to pick Medicare plans for your parents can be a little confusing. Did you know that 77 million people were born between 1946 and 1964? These individuals are known as baby boomers, and it’s likely that your parents are one of them. If you have a parent that may become eligible for Medicare or is already eligible, they can learn all about Medicare and compare plans online. They can even apply for Medicare plans online, which is much simpler than mailing in a form or going to the Social Security Office. If you want to know more about picking a Medicare plan for your parent, these are some tips to follow.

Types of Medicare Plans

There are actually a variety of Medicare plans. Most people think that Medicare is just one health insurance program that encompasses all of a person’s medical needs. Actually, Medicare breaks down into multiple parts or plans.

Original Medicare includes

• Part A – Hospital Insurance covers in-patient hospital care, skilled nursing care, home health care and hospice care.
• Part B – Doctor’s visits, blood tests, x-rays and outpatient care.

Medicare Advantage

• Part C – Medicare Part C plans cover Medicare Part A and Part B, but they also include extras like prescription drug coverage, vision and dental. These plans are offered privately through major health insurance companies. They typically have a low cost or may cost nothing. You still have to pay Part B premium if you choose Medicare Part C. You have one insurance card and pay one insurance company.

Medicare Part D

• Part D – Prescription drug coverage covers generic drugs for Original Medicare, but with Medicare Advantage, you may be able to get free generic drugs and discounted premium drugs. Prescription coverage is offered separately for those who have Medicare Part A and B, but it’s typically included with Medicare Part C.

Medigap

• Medigap – This is supplemental coverage to take care of services that Original Medicare recipients don’t have. You cannot get Medigap if you have Medicare Advantage.

Special Needs Plans

• SNPs – Special Needs Plans are only for certain people who qualify for this type of insurance based on their disability.

Typically, you will choose between Original Medicare and Medicare Advantage. MedicarePartC.com offers multiple articles with comparisons on these plans.

HMO, PPO or PFFS

Most Medicare plans will break down into Health Maintenance Organizations, Preferred Provider Organization or Pay-a-Fee-For-Service plans. These are known as HMO, PPO and PFFS. There are slight differences between these plans that might narrow the decision on what type of Medicare to choose for mom and dad.

Original Medicare

• PPO: Medicare operates like a PPO, but you can only see doctors, providers and hospitals that accept Medicare. You pay a monthly premium that is around $104 for Part B and typically do not have to pay for Part A. You can pick up a Medigap plan to cover your deductible and coinsurance.

Medicare Advantage

• HMO, PPO or PFFS: Medicare Advantage Plans are offered by private companies, which means that they offer a variety of different Medicare plans. Most of these plans are HMOs, which means that you will have to choose a primary care physician and have managed healthcare.
• If you choose a PPO, then you can pick the doctor who you want to see and go to the facilities that you want to go to, but they have to accept your plan and you may pay a fee for going outside of the network. For example, your co-pays may be higher.
• If you go with a PFFS plan, then you just have to make sure that a doctor or hospital accepts that type of insurance policy. Some do not accept Medicare Advantage. However, you can pick the doctor and hospitals that you want to see.

Costs of Each

– Original Medicare

• Medicare is free for some individuals who do not earn enough or who paid into the program long enough.
• You may have to pay for Medicare Part A, but most likely you will just pay your Part B premium. In some cases, you will have a deductible.
• You pay for prescription drugs or may qualify for Part D insurance separately.
• You may want to get Medigap to supplement your out-of-pocket costs like deductibles.

– Medicare Advantage

• Some Medicare Advantage plans are offered free through private health insurance companies, but you still have to pay a Part B premium in most cases.
• Only private insurance companies approved by Medicare can provide coverage, which means that you have to pick from their approved insurance providers.
• Extras like gym memberships, prescription drug coverage, dental and vision are most likely included
• Co-payment and co-insurance will be paid by you ni some cases.
• Plans vary depending on the carrier.

– Part D or Prescription Drug Coverage

• If you have Original Medicare, then you will pay a monthly premium and pick a separate Medicare Prescription Drug Plan through a private health insurance company.
• If you have Medicare Part C or Medicare Advantage, then prescription drug coverage is typically covered by your plan. You can still join a Medicare Prescription Drug plan separately if your health insurance carrier doesn’t provide it.

The costs with each plan will most likely depend on your lifelong earnings, total income from last year’s tax return, how many are in your household, degree of health, disabilities and spouse information. You may qualify for free Medicare.

– Medigap Policies

• These policies vary in cost depending on the company.
• You can supplement Medicare Part A and Part B plans with this coverage.

You may want to check with your parents’ employer to see if they are covered in retirement for health costs. You can also use the Eligibility Calculator on Medicare.gov.

Medicare Advantage is strongly encourage for those who like to be in control of their own health plans and want the option of going with a major health company rather than the government. There are many issue with the Medicare program, but it’s actually been reformed and provides a variety of ways for people who can’t afford healthcare to receive medical treatment and have a regular doctor. If you want to learn more about Medicare, we offer a variety of different compare tools and videos to check out.