These Things Might Surprise You About Medicare

Reading and researching information about Medicare can help you from being surprised down the road. While there are many benefits to Medicare over employer and other plans, there are some things that may pop up when you’re least expecting it.


Medicare Doesn’t Have an Out-of-Pocket Max

Unlike most employer plans, there is no annual out-of-pocket max for original Medicare. Original Medicare, or Part B, covers doctor and lab visits. These plans typically covers 80 percent of expenses leaving the individual responsible for the remaining 20 percent with no cap. However, individuals with Medicare Advantage plans and Medigap coverage typically have built in safeguards. Problems arise when a person only has Part A, B and/or D. Individuals can have a large and unexpected amount to cover. As with all Medicare plans, costs vary widely by your situation and coverage.


There is No Family Plan

Medicare requires each individual to have his/her own plan.  Again, unlike employer plans that typically have an option to cover you, your spouse and family, Medicare recognizes it’s common for spouses to have different health conditions and drug needs. Therefore, Medicare plans are based on the individual. Problems can arise if the individual carrying the insurance retires before the spouse turns 65. Be sure you are clear on the requirements and parameters so you can find alternatives for your family to maintain coverage.


Wellness & Preventative Care Vary Greatly

Wellness and preventative care can be critical to maintaining good health and catching problems early. Specific screenings and visits do vary by plan, but in general, every plan includes wellness and preventative care options. Medicare recognizes catching issues early often means they are easier, and in many cases, more inexpensive to treat. Wellness visits also provide a time to check in with your doctor and create a plan to ensure your continual optimal health. Some plans go as far as to cover hearing and vision coverage or in-home care appointments. Knowing what your plan offers for wellness and preventative care can save you greatly in the long run.


Prescription Drug Saving Opportunities Exist

Part D and, often, Medicare Advantage Plans cover or supplement prescription drug expenses. However, many Medicare participants don’t realize there are additional opportunities to save on prescription drug costs. Home delivery pharmacy benefits and preferred pharmacy networks often provide additional savings to participants. Additionally, although not the best alternative in every situation, you can ask your doctor if a generic drug or drug on a lower tier of your plan’s formulary could work as well for you.

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