Medicare Choices

Before choosing a plan we want to be sure you know the difference between your many options; In particular how Medicare Supplement Insurance Plans and Medicare Advantage Plans differ. Many people sign up for Medicare Advantage Plans thinking they are Medicare Supplement Insurance Plans, they are not.

 

MEDICARE SUPPLEMENT PLANS

MEDICARE ADVANTAGE PLANS

MEDICARE RX DRUG PLANS

We’ll help you learn all you need to know about Medicare and optimizing your coverage.

There are two different ways you can go:

      1. Medicare + Medicare Supplement (Medigap plan) & Part D Drug plan (if drug coverage is needed)
        2. Medicare Advantage Plan.

I've illustrated some of the differences between these plans below, but these are not absolutely exclusive or all-encompassing:

Medicare Supplement

Network: ALL doctors that accept Medicare, which is most doctors.

Copays: Varies depending on plan but could be NONE.

Deductibles: Varies depending on plan but could be NONE. As of Jan 1,2020 all new plans issued have a part B deductible of $240 (2024). Grandfathered non deductible plans pre 2020 may be rewritten (pending passing carrier underwriting) and bypass the deductible.

Cost: Varies depending on type of plan, age, gender, carrier and zip code. Supplement premiums increase yearly. Having a supplement necessitates a stand alone drug plan, with premiums,deductibles, varying based on carrier. Formularies and costs of drug plans can change from year to year.

Drugs: Need to purchase separate drug plan if drug benefits coverage is required.

Consistency: Plan benefits stay the same every year.

Eligibility: Must answer medical questions if outside initial open enrollment period. No health questions during the first 6 months when enrolling in Part B of Medicare.

Additional Benefits: None

Medicare Advantage

Network: Each plan (HMO's and PPO's) has specific networks. PPO plans let you go outside the network traditionally for an additional cost, however some plans now have the same cost for in and out of network coverage, giving similar network benefits as a supplement. HMO's will not pay for out-of-network medical visits or procedures.

Copays: In many cases 0 to $15 for primary care, $15 to $30 for a specialist, $0 -20 for bloodwork, $50 to $200 for diagnostic tests (x rays MRI, CT scan) and $100+ for hospitalization.

Deductibles: Can range from $0 to $1,250. You typically see a deductible on more antiquated plans, most of the new plans today do not have a deductible. If your plan currently has a deductible, please enquire about a plan benefit review, you could be overpaying.

Cost: Varies depending on type of plan and company chosen.

Drugs: Drug plan included with most plans, with no additional cost, saving you both the monthly premiums and the deductible of a stand alone prescription drug plan

Consistency: Varies with plan and carrier, benefits may change from year to year, many times for the better (adding additional perks).

Additional Benefit: Many Medicare Advantage Plans come with rich benefits, such as gym membership, vision coverage, dental coverage, and quarterly over the counter benefits.

 

Parts of Medicare

 

MEDICARE PART A

Part A (Hospital Insurance):
Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

MEDICARE PART B

Part B (Medical Insurance):
Helps cover: Services from doctors and other health care providers. Outpatient care. Home health care. Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment). Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

MEDICARE PART D

Part D (Drug coverage):
Helps cover the cost of prescription drugs. You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.