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The Complex World of Medicare

To many people under age 60, Medicare is a simple program: once you reach age 65, the government provides health care, using the money you have been paying in all of your working life. But as you approach Medicare age... 

(65), you learn there are a lot of options under Medicare.If you have worked for 40 quarters (ten years), you are entitled to Medicare Part A. That pays for hospital care. You are also entitled to Medicare Part B, which generally covers medical services (like doctor visits, lab tests and surgeries) and supplies (like wheelchairs and walkers), but you must pay a monthly premium for that coverage (currently $104 per month).You are also entitled to Medicare Part D, which will cover some of your prescription drug costs, but you pay a separate premium for Part D.Then there is Medicare Part C, also called Medicare Advantage. That is an option to enroll in a private health care plan instead of taking Parts A and B, or "traditional Medicare." If you elect a Medicare Advantage plan, the government pays a premium to that plan provider, using the money that would otherwise be used to pay for Medicare Parts A and B, The law requires that Medicare Advantage providers (private insurance companies) meet certain minimum criteria, but the provider will offer different coverages as an option to traditional Medicare. For example, you might find a Medicare Advantage plan offered by a private company (e.g., Blue Cross, Aetna, Humana, etc.) that has higher deductibles and co-pays, but includes optical or dental care. That might be more attractive to you than "traditional Medicare," which does not cover optical or dental care.Many people who have traditional Medicare have also purchased a "Medigap" policy. That is a policy thatsupplements the coverage of traditional Medicare. It might cover co-pays or deductibles that are not covered by traditional Medicare, or it might cover health care procedures not covered at all by traditional Medicare (like optical or dental.) If you have traditional Medicare, you may want one of those policies as well, or perhaps the retirement program from your former employer will provide a Medigap policy. (You cannot have a Medigap policy of you have chosen a Medicare Advantage Plan instead of traditional Medicare.)"Medicare offers so many options that the typical consumer is overwhelmed with the choices," says Chris Besonen, a health insurance specialist at Financial Architects Inc. in Farmington Hills. "Traditional Medicare does a good job of providing health care for the 'typical' enrollee, but nobody is really 'typical.' Some people need better dental insurance, some need better prescription coverage, and some need lower co-pays or deductibles. Choosing the plan that best fits your particular needs is a complex task," says Besonen. 

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