As a child growing up decades ago, I used to think that Medicare offered free medical coverage for senior citizens that covered virtually all their medical expenses.
I thought that after paying into the system during one's working years, it cost nothing for comprehensive coverage during retirement years.
I learned differently in recent years.
My new insights probably began a few decades ago from reading newspaper articles about Medicare and then from talking with my dad who was researching Medicare plans a few decades ago.
Over the last several months, I learned much more as I researched Medicare plans for myself.
Medicare.gov: Excellent Resource for Information
First of all, I want to state that the official government website Medicare.gov provides much guidance about the parts of Medicare, their coverage, when to sign up, how to sign up, costs, etc.
Please refer to it for authoritative guidance, not me. To learn basics, go to the Medicare.gov "Get started with Medicare" webpage.
That website basically discusses all that I mention below and much, much more.
Medicare also provides a booklet to Medicare recipients that covers a great deal of information about Medicare in over 130 pages. Below is a photo of my copy.
I urge you to consult the government's website and publications for accurate, official information about Medicare. But, below I briefly summarize some of what I learned.
Overview
I'm a firm believer in God. For many years when I had no human medical insurance, God blessed me with health. I'm confident even if I hadn't signed up for Medicare, God could bless me with health, making insurance unneeded.
And I support quality preventive care such as proper exercise, diet, rest, etc. But I know none of us engages in perfect preventive care.
I believe human health insurance has a purpose. And as we get older, we may need it more. God can work through human medical professionals.
So several months ago, I began researching Medicare in preparation for enrolling in it.
Some of What I've Learned
Medicare consists of five parts:
- Part A,
- Part B,
- Part D,
- Medigap or Medicare Supplement Insurance of various types,
- Part C or Medicare Advantage--also called Medicare Disadvantage by some, as discussed on the December 31, 2022, Ralph Nader radio show episode. The website MedicalWire lists what it considers some disadvantages of Medicare Advantage, while noting that it can be "good or bad. It all depends on your personal situation." As I neared age 65, private companies mailed me many solicitations about Part C.
Medicare A, B, D, and Medigap typically do not cover most dental care, hearing tests and hearing aids, or routine vision exams and glasses. Medicare also typically does not cover long-term nursing home care. If desired, separate dental, hearing, vision, and long-term care policies would need to be purchased from private companies.
Medicare Advantage (Part C) plans limit one to the particular private insurer's network, have other limitations, and are often more likely to deny medical coverage for various things. But Advantage plans may provide some dental, hearing, and vision coverage that regular Medicare doesn't. Like the other plans, they do not provide long-term care coverage.
Persons on Medicaid may get all Medicare coverage (and more) free. But only Part A and some Part C plans are free for typical persons. And high income persons must pay higher costs for Part B and Part D coverages.
Below I discuss the five parts of Medicare in more detail.
(1) Medicare Part A is free for most retirees due to deductions from paychecks during employment. It pays all covered hospital expenses for the first 60 days of the first hospitalization during the coverage period after a patient meets a $1,600 deductible. It also offers some coverage for extended stays and other stays. This is discussed in detail on the Medicare website. The Medicare.gov webpage "What Part A covers" discusses Part A coverage in detail.
(2) Medicare Part B costs $164.90 per month for most persons covered by it for 2023. After you meet a $226 deductible, it covers most outpatient medical expenses on a basis of 80% coverage and 20% copay. In other words, recipients pay 20% of most covered costs. The Medicare.gov webpage "What Part B covers" discusses Part B coverage in detail.
(4) Medigap or Medicare Supplement Insurance is sold by private companies. But what the plans cover is set by the government. Persons who purchase Medicare Parts A and B may purchase Medigap to cover many of the expenses not covered by Medicare A and B.
Several different Medigap plans exist. The various plans are designated by letters of the alphabet (A, B, C, D, F, G, K, L, M, N, and high deductible options for some of those). Medigap plans C and F aren't available for those who turned 65 in 2020 or later. Those two plans paid the Part B deductible which is currently $226. The government no longer allows coverage of that deductible.
The government standardizes what each supplement plan covers. For example, Plan G appears to be the most comprehensive one available for new enrollees now turning 65. It covers the $1,600 deductible for Medicare Part A, the 20% copay for Medicare Part B (but not the $226 Part B deductible), and some other expenses detailed on the Medicare website.
Even if you enroll in a Medigap plan during your initial eligibility period, you may be denied Medigap coverage for pre-existing conditions for up to six months unless you have creditable coverage, according to the websites MedicareInteractive, MedicareGuide, and other sources including page 14 of the 52 page official government guide "2022 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare." Your Medicare A and B would cover pre-existing conditions, subject to their usual deductions and copays.
A Medicare.gov webpage discusses what Medicare Supplement Insurance (Medigap) is.
Another Medicare.gov webpage provides more details about the various Medigap plans.
(5) Plan C or Medicare Advantage is a private insurance program. Persons enrolled in Medicare A and B may then choose to enroll in a Medicare Advantage plan, which typically encompasses A, B, some type of D, and maybe some dental, hearing, and/or vision coverage. But Medicare Advantage policies have a network of approved caregivers and may deny coverage that would be available under A and B of regular Medicare.
Plan C's monthly insurance costs may be low or $0. But if you need medical care, your out-of-pocket costs may be high.
Medicare Advantage advantages and disadvantages are discussed in a Consumer Reports article updated November 3, 2022. The Medicare.gov webpage "Medicare Advantage Plans" discusses Medicare Advantage plans in detail.
Signing Up for Medicare
Some persons are automatically signed up for Medicare Parts A and B at a certain time, such as those on disability. Also, those already drawing Social Security benefits for a certain number of months before turning age 65 are automatically enrolled when they become eligible.
These Social Security recipients who don't want to pay for Part B can opt out of Part B. But anyone who doesn't sign up for Part B when initially eligible may pay a higher rate as a penalty if they sign up later.
Persons not automatically enrolled, such as those not already drawing Social Security benefits for a certain number of months prior to age 65, need to sign up if they want to enroll in Medicare.
Persons first sign up for Medicare A (and if desired Part B). Then after A and B, one can also choose to enroll in Part D, and also a Medigap policy.
Persons who delay signing up for D but choose to later may pay higher rates.
Persons delaying signing up for Medigap but choosing to later may have their application denied or may pay higher rates if they can enroll. Also, your application for Medigap may be denied if you desire to switch from one Medigap plan to another after your initial six-month open enrollment period, as noted on a Medicare.gov webpage. Some plans may offer a low rate the first year, but raise it significantly as you get older, while at least one, affiliated with AARP, uses similar prices for various ages.
A Medicare.gov webpage notes that Medicare Supplement (Medigap) policies can be priced in three ways, (1) attained-age-rated, (2) issue-age-rated, or (3) community-rated.
For example, the AARP Medigap G plan from UnitedHealthcare is community-rated and may be more expensive for the first year at age 65 for a new enrollee than some other age-rated Medigap G plans, but those other age-rated plans may be significantly more expensive in future years.
As an alternative to Medigap and D, after signing up for A and B, one can sign up for a Medicare Advantage plan. The Medicare Advantage plan would replace the standard Medicare A and B, and the Medicare Advantage typically includes a Plan D.
Persons choosing to sign up for Medicare Advantage do not sign up for a Medicare Supplement Insurance plan.
The Medicare.gov website discusses details about how to sign up for the various Medicare parts. It also lists all the Medicare Part D, Medicare Supplement Insurance, and Medicare Advantage plans available to persons by zip code.
Changing Medicare Plans
Medicare recipients who desire to change the type of Medicare coverage they have, can do so during certain periods each year. Details are on the Medicare website.
But it's important to note that if you decide after over a year on a Medicare Advantage (Part C) plan to change from Part C with its limitations to original Parts A and B to get better coverage, you may not be eligible to add Medigap coverage. Medigap applications outside of the initial enrollment period may be denied.
Often persons who file bankruptcy due to medical bills or end up on Medicaid are persons with medical insurance, but who can't pay deductibles, copays, and other costs that are excluded from coverage under plans that offer limited coverage.
If you can afford it, it might be better to purchase a quality Medigap policy, such as Plan G, soon after you initially enroll in Medicare A and B, and add Part D too.
But for those on a tight budget, enrolling in Plan A by itself is usually free. And signing up for A and B, then switching to a low-cost Plan C is another one of the various possible combinations to lower insurance costs. Medicaid is another option for the poor.
Value
Medicare may not be comprehensive free medical insurance for recipients. But it is an excellent value. The cost of Medicare insurance is much lower than buying comparable private insurance.
Furthermore, if you sign up for the most comprehensive Medicare plans, your coverage is significantly better than most private insurance.
Medicare's Financial Situation
Numerous news reports have noted that Medicare (and Social Security) risks running out of money to pay full benefits in the future unless changes are made. Increases in revenue paid into the programs and/or cuts in benefits are likely in the future.
"A Summary of the 2022 Annual Reports" on the official Social Security website states "Social Security and Medicare both face long-term financing shortfalls." The article goes on to state that current data indicates that Medicare can only pay for Part A "until 2028." After that revenue will only pay for part of the expenses of Medicare Part A.
My guess is that Congress will take action in the near future to make necessary modifications to ensure the financial stability of Medicare. Congress may increase the Medicare eligibility age for young persons or increase the amount paid into the system. But it remains to be seen.
The best solution might be for we individuals to take better care of our health, thus reducing the need for professional medical care. I'm not a medical professional and can't give any medical advice. But in a 2019 Google Blogger article "True Health Care Reform: Better Preventive Care," I offered some suggestions for taking better care of our health.
However, my suggestions in that article are not perfect. And even if they were, I know that writing and reading such guidance is easier than following it.
My Choice, Recommendation, and Closing Thoughts
Each person makes their own choice on what to sign up for. Persons who have quality coverage from an employer may decide to delay signing up.
I signed up for Part A and Part B prior to turning 65, so their coverage would take effect at the beginning of the month I turned 65. Then I signed up for a Part D plan. Then I signed up for Medicare Supplement Plan G.
Plan A is free, but Plans B, D, and G, cost me a total of approximately $400 monthly for the particular choices I selected in my particular zip code. This cost is substantially lower than private insurance would cost.
God has blessed me with two part-time jobs I love that seem to benefit others and so far enable me to keep my budget balanced. Living in a studio efficiency apartment, not owning a car, and preparing most of my meals in my apartment are blessings that help lower the cost of living.
I recommend that persons who are within a year or less of turning 65 begin considering Medicare and the choices to be made. The federal government offers much guidance on its Medicare website.
Finally, while I am grateful for Medicare, grateful for two part-time jobs that I love, grateful for my health and all my innumerable blessings, and seek to live a healthy lifestyle, I know that the highest righteous power, God, is ultimately in control and deserves total credit for my health, my life, and all benefits in my life. Being healthy is better than having quality human medical insurance coverage.
Praises to God for all the innumerable blessings God will provide, provides, and has provided, including God's love, guidance, and patience in my life and in the lives of others. Let's all seek to discern and follow God's perfect leading, whatever that may be.
Disclaimer:
I am not a medical professional. I am not a medical insurance sales representative. And I am not a government employee. I am not qualified to provide professional Medicare or medical advice.
As far as I know, the information in this article was basically accurate when originally posted. However, I may have inadvertently made errors in posting the information.
Please consult the official Medicare.gov website for accurate, up-to-date, detailed official guidance.
I don't deserve credit for the facts in this article. They all basically came from the official government website, Medicare.gov.
This article provides my personal opinions. I am not paid by Medicare, any insurance company, or any insurance sales representative for expressing my opinion.
The husband of one of my sisters is currently an insurance sales representative whose work includes selling medical insurance and whose business includes dealing with Medicare, but I did not consult him at all in writing this piece. The views in this article are mine alone.
NOTE:
This article was last revised on April 10, 2023.
