Does Medicare insurance offer good coverage?

Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

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Question:

I am turning 65 later this year and I am nervous about getting Medicare. Is Medicare good insurance? Will I be happy with it?

Answer:

I LOVE Medicare! For anyone who knows me, that comes as no surprise. I have been working with seniors and their insurance for 30 years, and I find that the vast majority of individuals are very happy with their Medicare insurance and the accompanying products that go along with it.

I can also confidently say that the transition can be stressful and something that most individuals worry about before it happens.

Much of that worry and stress is related to the lack of understanding and knowledge about Medicare and how it works. Change is usually stressful. Most of us don’t like talking about Health Insurance – I understand that I am absolutely the exception to this statement!

The words and language associated with Medicare can be new and confusing. When you don’t understand what people are talking about, it is hard to be confident in your choice of insurance products. There are also a lot of choices that you will have to make for yourself, and that can be intimidating. So let me give you some positive aspects of enrolling in Medicare and then see if you feel more confident about what will happen.

Medicare has been around since 1965. “Original” Medicare consists of Medicare Parts A & B. Medicare Part A is the Hospitalization coverage and most Americans do NOT pay a premium for that coverage. Medicare Part B is the Medical Coverage – meaning outpatient services. Most Americans pay $185 per month for this coverage. When you compare that with plans that an individual could buy themselves, which average over $400 per month, Medicare is much less expensive.

But Medicare Part A & B is not the end of it. You definitely need to add some Prescription Drug Coverage. You can get that through a Medicare Advantage Plan or a stand-alone Prescription Drug Plan. Again, this involves making a decision about what you need.

In WNY counties, there are more than 60 such plans to choose from. That is a lot of options, so you can tailor the coverage you choose so that you have a plan that works well for you. In fact, there are so many options that I often see this decision intimidate more people than any other choice when they approach Medicare. Usually we get insurance from our employer or our spouse’s employer, where we often only have a few products to choose from. That feels much less intimidating. So once you approach the age of Medicare, I recommend that you look into your options and alternatives.

Another significant improvement to Medicare has been the introduction of Prescription Drug Coverage in 2006. Over the last few years we have seen significant improvement to the Medicare Prescription Drug Coverage Standard. In 2025, we have an annual Maximum Out of Pocket (MOOP) spending of $2000 for each individual for their medications. That is a very useful and affordable standard of coverage. Although the deductible in the beginning of the year feels high at $590, that deductible is included in the total MOOP of $2000.

When thinking about the cost of health insurance, in my opinion, Medicare coverage is very affordable. Medicare insurance rates do increase each year, but they are tightly controlled and rarely increase as much as employer plans and private insurance products. There have been many years where we have seen employer plans jump up in cost by double digits. Medicare usually increases closer to 2% to 5%.

Medicare has many preventative tests that are covered in full, no matter what type of plan you have. Just to name a few of these, mammograms, bone mass measurements, cardiovascular disease screenings, many cancer screenings (like cervical, colorectal, lung, breast, prostate), glaucoma screenings, Hepatitis B & C screenings, HIV screenings and abdominal aortic aneurysm screenings. Many vaccines are also fully covered across Medicare, including flu, hepatitis B, pneumococcal, and COVID. Part D benefits cover some vaccines in full, like Shingles, tetanus, RSV, DPT.

When comparing “Original” Medicare and those additional products with insurance options you have had up to this point, I think you will be pleasantly surprised with the Medicare coverage. I know that I personally cannot wait until I am Medicare eligible and able to make my own choices for insurance coverage.

Do a little research, talk to individuals who have Medicare, and I think you will find the same response from them: that Medicare is good insurance. They may not like the process of getting it started to think about it regularly, but most are happy with their insurance coverage overall!

I hope this makes you feel more confident as you approach Medicare age. The time you spend learning about Medicare and talking to people with Medicare will help you feel more comfortable with the coverage Medicare offers.