Many people don’t think about, learn about or even review Medicare until they either turn 65 or find themselves

in a situation in which they’re helping a loved one manage medical care. 

Sooner or later, you’re likely to interact with the Medicare system, and it’s not as intuitive as you might think.  I joined with Joseph Barrows — a licensed insurance agent at the Medicare Resource Center in Grand Junction — to help you better understand Medicare options before open enrollment begins Oct. 15.

Explore options? Isn’t Medicare free? The short answer is no.  Medicare isn’t free. Although you might see some of your medical expenses go down once you’re on Medicare, those expenses won’t disappear. Medicare actually works a lot like traditional insurance with co-pays, deductibles, monthly premiums and non-covered services patients must navigate.  

Let’s start with a little background. Original Medicare — the benefits enacted in 1965 and provided by the federal government — consists of Part A and Part B. Part A typically covers such expenses as hospital stays and inpatient care as well as rehabilitation, skilled nursing and hospice. It’s easiest to think of Part A as hospital insurance because hospital expenses fall under this category. There is a Part A deductible for inpatient stays of $1,484 in 2021 for the first 60 days. Part B can be referred to as medical insurance because such outpatient services as doctor visits, diagnostics and outpatient surgery are covered in this category. 

Part A is premium-free for most people. But Part B comes with a monthly premium based on your annual income. In 2021, most people pay $148.50 a month. Original Medicare Part A and B covers 80 percent of medical bills. Patients must cover the remaining 20 percent.

There are many services that aren’t covered by original Medicare. Hearing aids, dental cleanings, prescription drugs and long-term care don’t qualify. Most seniors require these services, so it’s important to consider how to handle those expenses. Fortunately, you have options. This is where Supplemental Medicare, Part D and Medicare Advantage come into play.

To keep it simple, I’ll discuss two main options.  Option 1 is called Medicare Supplemental and can be added to Medicare Part A and B. You can also add or decline Part D in Option 1, which is prescription drug coverage. 

Many people aren’t aware original Medicare won’t cover the prescription drugs you pick up at your pharmacy.  This can be a devastating realization for seniors who require multiple ongoing medications. I remember how my grandfather experienced sticker shock when, during the last months of his life, he needed a heart medication that cost him over $1,000 a month. He hadn’t budgeted for such an expense. For a person on a tight fixed income, it was a difficult expenditure to take on. He didn’t have a supplemental or Medicare Advantage plan. Since this occurred outside open enrollment, he had to pay out of pocket. As you explore your options, I encourage you to consider adding Part D to your coverage.

Option 2 is referred to as Part C or Medicare Advantage (MA). Unlike original Medicare, Medicare Advantage is offered through private insurance companies. Statewide, almost 45 percent of the population is on an MA plan, but less than 25 percent of the population in Mesa County uses MA plans. In Mesa County, Aetna, Anthem, Humana and Rocky Mountain Health Plans offer Medicare Advantage plans.

Medicare Advantage plans cover all the services of Medicare Part A and B and offer additional benefits. For example, Medicare Advantage covers the cost of health club memberships under some plans. Other benefits include routine physicals; dental, hearing and vision exams; and hearing aid discounts. That’s not to mention over-the-counter purchase cards and meals after a hospital stay. 

Many MA plans require modest monthly premiums, but some are zero. The nationwide average MA monthly premium is $25.

The main benefits of Medicare Advantage over original Medicare include a maximum out-of-pocket patient expense, fixed co-pays for most procedures and can include the Part D prescription drug plan. Having one carrier offers convenience and keeps things simple. Be aware, though, exceptions include oxygen and chemotherapy drugs as well as such durable medical equipment as prosthetic devices and wheelchairs. These remain under the 20 percent coinsurance, like original Medicare. 

As you research the right Medicare plan for you and your loved ones, it’s important to make sure the plan you consider includes the providers you wish to see or the cost involved if you continue to see a provider out of network.

If you sign up for a Medicare Supplemental or Medicare Advantage plan, it will function like traditional insurance. Some plans have a more restrictive network of hospitals and doctors than others. You should also make sure the prescription drugs you take are covered and which Part D plan is best for you based on their costs and coverage.  

The website at Medicare.gov offers a great place to start to learn more and compare plans. As you research your options, we recommend writing a list of questions  — alongside your provider and prescription list — to take to a Medicare insurance agent. Agents are paid by the companies they work for, not their clients, which make them a great and safe place to go before you enroll. Agents are also independent of insurance companies, so they’re able to work in your best interest and find a plan that suits your needs.

If not annually, we would encourage you to review your plan at least every couple of years. Like all insurance, Medicare plans can change from one year to the next.  

Save the date — open enrollment to sign up for or switch your Medicare plan is Oct. 15 to Dec. 7.

Ashley Thurow is executive director of Monument Health, a clinically integrated health network that works with hospitals, providers and insurance to create innovative health solutions for its members. Monument Health offers Medicare plans in its network.

Joseph Barrows is a licensed insurance agent and sales director at Medicare Resource Center of Grand Junction. For more information about Monument Health, call 683-5630 or visit www.monumenthealth.net.