As you get ready to turn 65, you may be inundated with information about Medicare. All this information is confusing, but it is important to do your research before choosing your plan. If you aren’t fully informed, you could end up making mistakes that will cost you down the road, particularly when it comes to how "Medicare Advantage" and "Medigap" plans interact.
The first thing to understand is Medicare’s alphabet soup of options. One option is traditional Medicare. This consists of Part A, which covers hospital stays; Part B, which covers physician and other outpatient charges; and Part D, which covers prescription medications. In addition, you can purchase a Medigap policy that covers some of the gaps in Parts A and B. Another option is Medicare Advantage (Part C), which permits Medicare beneficiaries to receive their medical care from private companies in one package and without the need for a Medigap plan. You must enroll in Part A and Part B in order to join a Medicare Advantage plan. In general traditional Medicare offers more flexibility with regard to doctors while Medicare Advantage plans tend to be managed care plans, which means only certain doctors and providers are covered. For more information about the advantages and disadvantages of Medicare Advantage, click here.
The first step to choosing the right option is to think about your health care needs. Do you need to see specialists regularly? Do you want vision or dental services? Is it important to be able to see providers nationwide? These are some of the considerations when choosing between traditional Medicare and Medicare Advantage. For more information about the two choices from the Medicare Rights Center, click here.
If you decide to go with traditional Medicare, you also need to decide whether you also want a Medigap policy and a Prescription Drug plan. For more information on what to look for in a prescription drug plan, click here. For help choosing a Medigap policy, click here.
Medicare has an annual open enrollment period in which you can switch from Medicare Advantage to traditional Medicare or vice versa. However, it's not so simple to switch from Medicare Advantage to a Medigap plan that supplements traditional Medicare. If you apply for a Medigap policy within six months of enrolling in Medicare Part B, a Medigap insurer can't refuse to sell you a plan based on a preexisting condition, but after that, insurers can refuse to sell you a policy, delay coverage, or charge a higher premium because of an existing health condition. Think about this when deciding between traditional Medicare and Medicare Advantage. For more on the Medigap/Medicare Advantage decision from the Center for Retirement Research, click here.
If you leave traditional Medicare for Medicare Advantage and then decide to return to traditional Medicare, you won't face quite the same problem with Medigap. Once you return to traditional Medicare, you have the right to go back to the same Medigap policy you had before you joined the Medicare Advantage plan, provided the same insurance company you had before still sells it. If the policy is no longer available, you have a guaranteed right to buy a Medigap policy designated A, B, C, F, K or L that is sold in your state by any insurance company as long as you had Medicare Advantage for less than a year.
There are many resources available to help you with your Medicare decisions. The Medicare.gov Web site allows you to find and compare plans, AARP offers a Medicare question and answers tool, and Consumer Reports has a guide to getting the most out of Medicare.
For more on what you need to know about signing up for Medicare, including the possible penalties for delaying signing up, click here.
For more information about Medicare, click here.
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