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Medicare Doesn't Cover Everything

One of the biggest myths about Medicare is that it covers everything. Unfortunately, that’s not the case. When you’re enrolled in Medicare, you’ll still have to pay for copays, deductibles, and premiums.

Original Medicare 
Original Medicare is the traditional government-sponsored health insurance program. It primarily serves individuals who are 65 years or older, as well as certain younger individuals with qualifying disabilities. 

Original Medicare consists of two main parts: 

  • Medicare Part A: This part covers hospital insurance. It helps pay for inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. Most people do not have to pay a premium for Part A if they or their spouse have paid Medicare taxes while working. 
  • Medicare Part B: This part covers medical insurance. It helps pay for doctor’s visits, outpatient care, preventive services, and some medical supplies. Part B does require a monthly premium, and the amount is based on the individual’s income.

Beneficiaries are still responsible for deductibles, copayments, and coinsurance. To fill the gaps in coverage, many people choose to get additional insurance, such as Medicare Supplement (Medigap) plans or Medicare Advantage plans (Part C). 

Medicare Advantage Plans 
Medicare Advantage plans, also known as Medicare Part C, provide an alternative option for those who prefer more comprehensive coverage and additional benefits beyond what Original Medicare offers. These plans are provided through private insurance companies and combine the coverage of Medicare Part A (hospital insurance) and Part B (medical insurance) and often include additional benefits not offered by Original Medicare. 

Most Medicare Advantage plans have a network of doctors, hospitals, and other healthcare providers with whom they have contracted. To get the full benefits, you may need to use healthcare providers within the plan’s network. However, some plans may offer out-of-network coverage, but it may come with higher costs. 

Medicare Advantage plans often have different cost structures, such as copayments, coinsurance, and deductibles. Some plans may have low or even zero monthly premiums, but beneficiaries may still need to pay copays or coinsurance for services. 

Original Medicare vs. Medicare Advantage 
With Original Medicare, you’ll pay monthly premiums, but there will be fewer surprises when medical issues arise. Medicare Advantage plans might have a zero monthly premium, but they can come with higher out-of-pocket costs for services. It’s crucial to understand your health needs and financial situation to decide which plan works best for you. 

When you have to pay a copay, the amount will vary based on the specific doctor’s visit or medical service. The copay is determined by the type of plan you have, and it can be different for each individual.  

Talk to an Expert 
Understanding Medicare can be overwhelming, and that’s where the experts at ReJoyce Financial come in. If you want to learn more about your Medicare options and how to make informed decisions, call (317) 903-9157 or fill out the form below to schedule a no-cost, no-obligation visit. 

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