The Most Important Fact To Know When Going On Medicare
When you first go on Medicare there is one fact you need to know that is far more important than anything else.
In all but four states - Connecticut, Maine, Massachusetts and New York - the only time you can enroll in a Medicare Supplement without passing a health screening is when you first go on Medicare Part B.
This is because after you have been on Medicare Part B for 6 months, you will have to answer health questions as well as have your health history reviewed via insurance and pharmaceutical claims databases, if you apply for a Medicare Supplement. There are many conditions that will cause your Medicare Supplement application to be declined.
This means if you do not enroll in a Medicare Supplement when you first go on Medicare Part B, you may never be able to get a Medicare Supplement.
Original Medicare combined with a Medicare Supplement is the equation that gives you the best chance for the best health outcome if you ever have a serious health issue at a reasonable, predictable cost.
With Original Medicare combined with a Medicare Supplement, you will pay a small deductible every year, in 2025 this deductible is only $257, and after this deductible is paid all of your Medicare-eligible health costs are paid at 100 percent.
Whether you have an uneventful health year with only routine doctor visits or a year with multiple hospitalizations and extensive types of care, your out-of-pocket costs will, at most, only be $257.
On the other hand, private, for-profit insurance companies like Humana spend tens of millions of dollars every year on deceptive advertising trying to get you to bypass Original Medicare and instead enroll in a Medicare Advantage plan.
Medicare Advantage is not Original Medicare.
Unlike Original Medicare which allows you to receive care from almost any doctor or hospital anywhere in the country, Medicare Advantage plans limit your care to a group of doctors who have agreed to their compensation and coverage guidelines. Medicare Advantage coverage guidelines are much more restrictive than Original Medicare.
Additionally, unlike Original Medicare, most Medicare Advantage plans require pre-approval for most major care and even require referrals to see a specialist.
Most Medicare Advantage plans can require you to pay up to $7,000 or more when you need health care.
The smart approach to Medicare is to stay with Original Medicare and enroll in a Medicare Supplement when you are first eligible and your approval is automatic.
Charles Bradshaw is the President and Founder of Medicare Answer Center and the author of “Medicare is not one-size fits all” and “The Medicare Advantage Trap.” He can be reached at charles@bradshwseniorinsurance.com.