The purpose of this section is to provide educational information only so that those living with Parkinson's can appropriately guesstimate how to plan for future health insurance coverage needs. Prior to signing-up for any medical coverage, it is important that each person thoroughly read and obtain guidance directly from medicare.gov or a licensed Medicare agent.
Due to the increased need of medications, hospitalizations, and therapies, it is highly recommended that anyone diagnosed with Parkinson's to strongly consider the purchase of a Medicare Advantage Plan or Medigap Plan to cover additional expenses related to the treatment of Parkinson's disease. Most have found these plans more than cover their out-of-pocket-costs. Also, having a limit to out-of-pocket expenses annually can help with budgeting and offer greater peace of mind.
Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesn't cover - like vision, hearing, and dental services.
You can join a plan offered by Medicare - approved private companies that follow rules set by Medicare. Each plan can have different rules for how you get services, like needing referrals to see a specialist. Costs for monthly premiums and services you get vary depending on which plan you join.
Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. Some plans tailor their benefit packets to offer additional benefits to treat specific conditions.
With Medicare Advantage, You:
Need to use doctors who are in the plan's network (for non-emergency, non-urgent care)
May pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premiums.
Can't buy or use separate supplemental coverage (like Medigap)
You must have both Part A and Part B to join a Medicare Advantage Plan.
How does Medicare work with my other insurance?
When you have Medicare and other health insurance (like from your job), one will pay first (called "primary payer") and the other second (called a "secondary payer"). If you have other insurance who pays first depends on several items, like if you're still working, and the type of insurance you have.
Navigating what plans are best, can be complicated. You may need to consult with a Medicare Advisor. Independent advisors from the government can also provide you with guidance to Medigap and Medicare Advantage plans to ensure you are getting the best coverage. In summary:
Part C - Medicare Advantage Plan
Medicare Advantage is a Medicare approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These "bundled plans include Part A, Part B, and usually Part D"
In most cases, you'll need to use doctors who are in the plan's network. Plans may have lower out-of-pocket costs than Original Medicare
Plans may offer some extra benefits like Original Medicare doesn't cover - like vision, hearing, or dental services
How Do I Know if a Medicare Advantage Plan is Worth It?
Affordability: First, you must shop to see if you can afford the monthly payments by comparing available plans - versus opting into all Original Medicare Plans.
Doing the Math: Are the added monthly payments worth the risk or peace of mind you might get compared to unknown out-of-pocket costs? With a Medicare Advantage Plan you can understand the maximum investment you make every year.
Planning for the Unknown: While your monthly premiums could cost you more, what happens if you need more than Original Medicare covers even if you have Parts A, B and D. What happens as the number of hospitalizations and prescriptions increase? While there is coverage - there is no limit to copayments for each new prescription and hospitalization.
At the end of the day, it is a personal choice. We hope we have provided educational content to help you discern which path may be best for you as you select which health insurance option best meets your needs.
Disclaimer: At PAA, our desire is to be a GO TO Resource for everything you need for the Parkinson's diagnosis to live a quality life with PD. We want to make sure you have all resources you need as you plan your journey with Parkinson's now and into the future so that you can reflect and discern what decisions you want to make with the appropriate insights to help you choose and build a plan that is unique as your journey. The PAA, nor the contents on this website, should never be a replacement for professional expertise and guidance from medical, legal, or financial professionals. Our goal is to equip you for those conversations. As such, the PAA cannot be held accountable for your choices and outcomes while navigating your Parkinson's condition.
Alabama Medicare- Applying for Medicaid Benefits: https://medicare.alabama.gov/