How To Get As Much Of Your Medical Care Covered Once You're On Medicare
Reaching the age at which you can enroll in Medicare is a relief to many; the lower out-of-pocket costs and wider coverage of Medicare are a blessing after dealing with standard health insurance. But Medicare doesn't cover everything, and if you want to ensure that as much of your care is covered as possible, you need to take certain steps. These include choosing your plan carefully and getting supplemental coverage, called Medigap.
You Must Have Original Medicare
The best way to ensure that your medical care is covered according to the policy you signed up for is to choose original Medicare and not Medicare Advantage. The Advantage plans are cheaper but function a little more like standard non-Medicare health insurance, which means you're at risk of not being able to see certain specialists or seek treatment from certain networks. You have a closed network similar to what you have with standard health insurance, so if you see a provider, you have to ensure they're in-network. Otherwise, you'll have to pay for everything associated with that visit. Chronic visits and treatments may also not be as well-covered by an Advantage plan as they are by original Medicare. And most of all, original Medicare allows you to buy supplemental plans to further customize your coverage. You can't get those if you have Medicare Advantage.
You Need a Standardized Supplemental Plan
For coverage that is renewable and not something that you have to worry about losing, look for a standardized supplemental Medigap plan. Some states allow non-standardized plans, so you'll have to ensure that the plan you choose is standardized; never assume. But these plans will help remove some of the pain of paying out of pocket for things like co-pays and other costs that your main Medicare plans won't pay. You will pay premiums, but some states place caps on those, and even in the states that don't cap Medigap policies, the premiums aren't distressingly huge.
You Must Treat Those "Routine" Visits Carefully
Original Medicare has a strange bit of non-coverage: It doesn't cover routine physicals. However, it does cover a wellness exam each year after the first year of coverage. The wellness exam is standard and looks at specific issues; those can change from year to year (e.g., it may allow for certain tests every couple of years instead of every year). This can be confusing to navigate at first because really, what's the difference between a routine physical and wellness exam that both check your blood pressure? However, your doctor can help you learn more about the two and what you can have done at the wellness exam that will be covered. Once you know, you won't unwittingly ask for a test that isn't covered.
Of course, if you go to the wellness exam and still want to get that non-covered test, you can. You will be billed for it, but if you go in knowing that you'll be billed, you won't have to deal with surprises later on. If you can get a Medigap plan that covers the costs in question, that's even better.
Original Medicare plus a supplemental plan, or Medigap plan, can help cover those costs that you'd otherwise have to pay out of pocket. Even if you still end up paying some cash after getting as much supplemental coverage as you can, the amount will be greatly reduced thanks to those supplemental plans.
For more information, contact a Medicare supplement provider near you.