Medicare Advantage and Supplement Plans?

Many people are not aware of the various plans available to Medicare beneficiaries. Yes, they all complement Medicare but there are some major differences! Your personal values, finances, and health status determine which plan is the best suited for you, your family, and your lifestyle. It is important to make a wise decision due to the number of rules around changing plans. You could be trapped in a plan you do not like and may be unable to change! Speak to an independent agent for more information.

What is a Medicare Supplement policy?

• A Medicare Supplement policy – or Medigap plan – is a health insurance policy made available through private insurers designed to cover the expenses not covered by Original Medicare. These began in the early 1980s.
• Federal law mandates features and benefits of the various Medicare Supplement (Medigap) policies.
• Benefits are standardized and are the same among private insurers who make this coverage available. Monthly premium price is the only difference between the insurance carriers.
• You can see any health care provider allowed by Medicare.
• You do not need a referral to see a Specialist.
• There is no network; you are free to travel!
• Monthly premiums and plan features for Medicare Supplement (Medigap) plans can vary widely, depending on the type of plan you choose. Depending on your circumstances, you may need certain features that not all the plans offer. For example, some plans offer emergency coverage while you are traveling overseas, while other plans do not.
• Easy to budget! Premiums are entirely predictable so you can make wise financial decisions.
• Often NO billing and paperwork for you to complete at health care providers’ visit or procedure.
• A Medicare Supplement (Medigap) policy only works with Original Medicare. These policies do not work in conjunction with Medicare Advantage, group health insurance plans, or VA/TRICARE benefits.
• Prescription drug coverage is not included with these plans. You may want to purchase a stand-alone Part D Prescription Drug Plan.

What is a Medicare Advantage Plan?

• A Medicare Advantage (MA) plan is a managed care plan offered by health insurance companies, and some hospitals. These plans originated in 2006 due to new legislation regarding Part D, prescription drug laws.
• Monthly premiums start at zero dollars ($0) per month and range up to several hundred dollars per month.
• Come with co-pays and deductibles, with out of pocket maximums up to $6,700 or $10,000 per year.
• Each plan has a specific network of providers.
• Sometimes you can pay more and go outside the network.
• Typically you must have a Primary Care Physician refer you to see a Specialist
• Some come with a Part D, Prescription Drug Plan (PDP); often called a MAPD plan, some do not.
• Harder to budget because of the uncertain amount of co-pays and deductibles. You pay for what you use.
• Often there is billing and paperwork for you to complete at each health care providers’ visit or procedure.
• Growing in popularity due to extra benefits Medicare typically does not pay for such as a fitness center, hearing aids, and routine vision care benefits. More extra benefits are coming in the next year or so!
• Choose plans based upon your geographic location. Plans can be severally limited, or non-existent, in low population density or rural areas.

Whatever you do, learn as much as you can so you make a wise decision for you and your family. Talk with an independent agent who works for you not the insurance company!

Hilary Greenbaum
Howard Insurance Agency for Seniors