Paul Barrett Insurance Services Blog
Medicare Advantage vs. Medicare Supplement Insurance Plans AKA( Medigap)
Medicare, is a multilayered federal health insurance program for people 65 or older or for people under 65 with certain illnesses or disabilities, can be confusing. While Medicare Part A covers inpatient hospital stays, hospice care, skilled nursing facilities and some home health care services, Medicare Part B covers outpatient care, doctors’ services, preventive services and medical supplies. These come standard in every original Medicare plan.
Medicare Advantage, also known as Part C, is an alternative plan that adds extra benefits. Stand-alone prescription medication coverage, called Plan D, allows you to keep your original Medicare plan with the added benefit of covering the costs of your prescription medicines.
However, as you may remember during your experiences with insurance while you were working, there are always other expenses to consider. Many people think Medicare covers all health care expenses, but this is not so. It does not cover some copays and fees.
Here are some examples of costs you may be responsible for when using Medicare for health care needs:
Medicare Advantage Plans are best suited to individuals who are on a limited budget or those who would rather have a smaller premium in lieu of high out-of-pocket costs. Here are five things to consider when choosing a Medicare Advantage plan:
Medicare Supplement Insurance
How it relates to Medicare Parts A & B
Private supplemental coverage that pays all or most Part A & B out-of-pocket costs
Private health plan; provides Part A and B benefits in place of original Medicare
Varies greatly by plan and state may also be more depending on health and age.
$0-$100 a month; all enrollees pay the same regardless of age, health history
Low to none (except for premium)
In-network medical deductibles, copays up to $3,400-$7,200 a year, depending on plan
Doctor, hospital choices
Any that participate in Medicare
HMOs: Plan providers only
PPOs: Any provider; out-of-network costs more
When you can buy
First six months after you sign up for Part B and at least 65; you can be turned down or charged extra in most states after this period
When you first enroll in both Medicare A and B; annually thereafter during open enrollment Oct.15-Dec.7
Part D (drug) coverage
Most plans include Part D
Quality info available
No standardized ratings
Medicare.gov has star ratings, with higher stars being the best
Proof of coverage
Little to none; usually automatically sends payment to providers after Medicare’s fulfillment
Some, because you pay deductibles and copays directly to providers
Medicare Supplement Insurance Plans (Medigap)Medicare supplement insurance plans are a different option for additional Medicare coverage. If you plan to keep your original Medicare insurance and pay your Part B premium, consider a Medicare supplement insurance plan instead to cover the “gaps” in traditional Medicare costs. Some plans even pay the Medicare Part A deductible, so it truly matters that you do your research before making a decision.
Five things to consider when choosing a Medicare supplement insurance plan include the following:
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