By Kim Hulme, SHIBA Partner 208-847-0949
The above question is one of the most common questions that I get as a Senior Health Insurance Benefits Advisor (SHIBA). I believe this question is most often prompted by ads that people are seeing on television. The answer is a two-part explanation of the two different kinds of Medicare and what benefits each provides.
Traditional Medicare is referred to as Medicare A (inpatient hospital coverage) and Medicare B (outpatient medical services). A Part D prescription drug plan also falls in this category. Traditional Medicare can be used anywhere in the U.S., as long as the provider accepts Medicare, (which is usually the case.) There are some things traditional Medicare does not cover, such dental, hearing, and vision. Cataract surgery and jaw surgery are some of the few exceptions to that rule. Medicare recipients can purchase vision, dental and hearing coverage separately if desired. Traditional Medicare does offer several screenings. If you are not taking advantage of these screenings, you are not getting all the benefits you could be getting through Medicare.
Medicare Advantage Plans
A Medicare Advantage (Part C) plan is another way to get your Medicare A and Medicare B coverage, and in many cases, a Part D prescription plan. These plans are administered by private, for profit, companies, and these are the plans you are seeing advertised on television. Many of these plans offer some dental, vision, and hearing benefits. Often the dental coverage only includes an oral exam, cleaning, X-rays, and flouride treatment. Plans differ in how they cover these extra benefits. Advantage plans can have large out of pocket expenses, anywhere from $5500 to $10,000 per year. In addition, many of them are HMO plans so these plans only pay if you visit a doctor or facility in network. This could be problematic if traveling or visiting out of state. Some Medicare Advantage plans have premiums that are almost the amount you might pay for a Medigap plan if you have traditional Medicare. In addition, some of these plans do not have drug coverage, and if you are enrolled in one of these, you cannot purchase a separate Part D plan.
Medicare Advantage plans are state and county specific. Several rural counties across America, and especially here in Idaho, do not have Medicare Advantage plans. Bear Lake county is one of those counties. Areas with lower population base do not produce the revenue that Medicare Advantage plans find acceptable.