ARTICLE: Is Traditional Medicare Worth It?

Is Traditional Medicare Worth It?

In order to decide if traditional Medicare is worth it,

the senior citizen must first confirm that the Alternative Medicare Advantage plan to be provided within his or her geographic territory can provide satisfactory health care. This is because a Medicare Advantage plan is owned by a private company that provides all of the beneficiary’s health care and prescriptions through that plan’s health care providers for a capitated rate paid the provider by the Centers for Medicare and Medicaid.

While the Medicare Advantage company must provide all the services currently available under Medicare Parts A and B, the primary physician who is assigned to the Medicare Advantage beneficiary serves as a gatekeeper to specialists. The beneficiary’s health care cost to the provider is reduced while his or her insureds are maintained by the provider.

A Medicare Advantage beneficiary, however, loses the right to select any doctor and must select only from a panel of physicians offered by the plan.

Thus, it is important that the senior citizen first study the list of the policy’s providers and hospitals and be confident with the quality of health care those doctors and hospitals listed on the plan are providing. Likewise, only certain pharmacies will fill prescriptions for the plan participant. The senior citizen also must know that the plan’s hospitals, doctors and pharmacies may change each year.

In the alternative, the senior considering traditional Medicare should be confident that he or she has the financial ability to pay the $1,364 first day hospital deductible for each new spell of illness. This is not paid by Medicare. A new Medicare spell of illness arises every time the patient has not been readmitted within 90 days of discharge. Seniors need to know that there is a $341 per day deductible for the 61st through 90th day in the hospital during the same spell of illness in 2019. In addition, a patient is allowed a maximum of 60 lifetime reserve days with a $682 per day deductible in 2019.

Each year, there is an adjustment to the initial deductible, co-insurance amount and lifetime reserve daily amount.

Medicare Part B does pay for the physician’s examinations and treatments.

The standard monthly premium for Medicare Part B enrollees is $135.50 for 2019. Medicare Part B also has an annual deductible that is at least $185 in 2019. To further explain, every year, before Medicare pays anything, the patient must incur medical expenses equal to the deductible, based on Medicare’s approved reasonable charge, not on the provider’s actual charge.

In addition, there is a co-insurance amount which the patient must pay. This is equal to 20 percent of the Medicare approved amount. “Medigap” is the term used to describe the supplemental insurance policy needed to cover the health care costs, deductibles. and co-pay amounts not provided by Medicare. The purchase of this policy is important for Medicare recipients who rely on traditional Medicare coverage Medicare Part A.

We know this article may raise more questions than it answers. With Medicare Open Enrollment right around the corner for this year, we encourage you to learn more and reach out to us with your questions.

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We at Roth Elder Law, PLLC, believe in providing services in a way that clients can easily understand and meaningfully participate in designing and maintaining their estate plan for their loved ones, as well as be assured that their plan will be administered according to their wishes.