Finding Your Way Through the Gaps and Traps of Original Medicare

Medicare doesn’t cover everything, leaving gaps and high out-of-pocket costs. Learn about ourt plans that can fill those gaps and provide additional coverage options.

If you’re soon to be or have recently become eligible for Medicare, you should know it doesn’t cover everything. These gaps can leave you with high out-of-pocket costs. It’s crucial to look at extra coverage options. In this article, we’ll discuss the Gaps and Traps of Medicare. We’ll also look at how Medicare Advantage and Medicare Supplement plans can help fill those gaps.

The Gaps and Traps of Medicare:

  1. No annual limits: Original Medicare doesn’t have out-of-pocket limits. If you need a lot of medical care in a year, you may have to pay a lot out of your own pocket. Both Medicare Supplement and Medicare Advantage plans give you a safety net. They have annual limits for your medical bills that Medicare alone does not have.
  2. Missing your guaranteed issue rights: When you are new to Medicare or when you first leave group health insurance, you have a short window of time with guaranteed issue rights. After that time, you may not be able to sign up for a Medicare Supplement plan, also known as Medigap. This means if you wait too long to enroll, you may be denied coverage, or you could be charged higher premiums based on your health status. In fact, 25 percent of older adults in South Carolina have conditions that could cause supplement rates above the standard premium or a decline from Medicare supplemental coverage completely. You can always decrease your level of health coverage as you age, but you cannot always increase your coverage if you’ve been ill or injured or have a chronic health condition. To avoid missing out on guaranteed issue rights and new-to-Medicare discounts, enroll in a plan three months before you turn 65.
  3. Out-of-pocket expenses: With Medicare, you are responsible for paying deductibles, coinsurance and copayments. These can add up quickly for inpatient hospital stays, skilled nursing facilities and outpatient care. With Medicare Part B, you pay 20 percent of an unlimited amount for outpatient care like sick visits at the doctor, emergency room visits, outpatient surgeries, chemotherapy, labs, MRIs and physical therapy. For example, if you need an outpatient surgery that costs $100,000, you would owe $20,000 in medical bills on regular Medicare. Getting a Medicare Advantage or Medicare Supplement plan can reduce the amount you have to pay out of your pocket for care.
  4. Prescription drug late enrollment penalties and lockouts: Original Medicare doesn’t cover most prescription drugs. You must enroll in a separate Medicare Part D plan through a private insurance carrier. You should do this within two months of losing group health insurance or when you are new to Medicare, whichever comes last, to get coverage for prescriptions. Unless you have drug coverage through a program like Veterans Affairs, you may face late enrollment penalties for life if you enroll in drug coverage after your initial coverage election period. In addition, if you’re not new to Medicare, you can only enroll in drug coverage certain times each year, like the annual enrollment period from Oct. 15 – Dec. 7. That’s why it is important to complete your application for Medicare Part D, drug coverage or a Medicare Advantage plan that covers prescription drugs before you retire.
  5. Excess charges: If you get care from a doctor who doesn’t accept Medicare as full payment of the bill, you might have to pay even more than the 20 percent standard Part B coinsurance. A Medicare Supplement plan like BlueCare® Plan G or High-Deductible Plan G from BlueCross BlueShield of South Carolina will cover Part B excess charges. This will give you the lowest medical costs at the most doctors’ offices nationwide.
  6. Limited coverage: Original Medicare doesn’t cover things like prescription drugs, dental, vision and hearing care. Many Medicare Advantage plans can improve your quality of life with value-added services Original Medicare does not offer.
  7. Foreign travel coverage: Original Medicare generally does not cover medical care outside the U.S. With extra coverage through a company like BlueCross, you can travel the world with peace of mind.

Filling the Gaps and Traps

Now that you know the gaps and traps of Original Medicare, explore your options to make sure you have all the health coverage you need. A BlueCross agent can help you understand your coverage options and find a plan that fits your needs and budget. Don’t wait until it’s too late to get the coverage you need. Contact a BlueCross agent today to get started!

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