Plans with Different Coverage
Most people on Medicare report that they are satisfied with their health insurance coverage, but many people complain the program is very complicated. Medicare offers several different plans, coverage choices, premium levels and enrollment rules that can make it difficult to know what to pick and if you are covered adequately.
Medicare Advantage is a Medicare Replacement Program offered by a private insurance company. Medicare Supplement, also known as Medigap, helps cover expenses not covered by Original Medicare such as copayments, extra fees and deductibles. As you read below, you can learn more details about both of these plans.
The Basic Parts of Medicare
Part A
Part B
Part C
Part D
Medicare Advantage
Coverage replaces Original Medicare and is offered by private insurance companies that are approved by Medicare.
How?
Well, every month, Medicare pays the private insurance company a fixed amount, and that company covers your costs, according to guidelines set by Medicare. These companies provide all the benefits of Part A and Part B, with the exception of hospice care (that remains covered by Medicare Part A). These plans sometimes also include additional benefits, such as vision, dental, and/or prescription drug coverage. Note that people with end-stage renal disease (ESRD) generally do not qualify for Medicare Advantage plans. When you join a Medicare Advantage plan, you must continue paying your Part B premium.
Medicare Supplement
Also known as Medigap
While Original Medicare covers much of your medical costs, it still requires you to pay many fees such as copays, coinsurance, and deductibles. These fees can add up and many retirees are unable to afford them.
While Medicare Supplement plans help with deductibles and other expenses not paid by Original Medicare, they do not cover services if Original Medicare does not cover them. For example, they do not cover long-term care, dental care, or eye glasses.
Most people who are not comfortable with the Medicare Supplement monthly premium consider Medicare Advantage (MA). Unlike Medicare Supplement, MA replaces your Original Medicare. It doesn’t fill in all the gaps but the premiums are usually less expensive.
How Do I Choose?
What is your budget?
Medicare Supplements pay for all or most of your doctor and hospital bills. Medicare Advantage payments can vary.
What are your coverage needs?
Coverage will vary between the two options making it important to choose the right plan for your needs. Medicare supplements rarely include additional services, such as vision and dental. However there are Medicare Advantage plans that will offer these extra services.
Choice of doctors?
Medicare Supplements allow you the flexibility to see a doctor or specialist without a referral. When enrolled in Medicare Advantage, you would be using a network of doctors while paying a bit more to see a doctor outside of your area.
Both Medicare Supplements and Advantage Plans have a specific time period to apply.
If you miss the deadline, you risk being underinsured or not insured at all.
The best time to sign up for Medicare, Medicare Advantage, Medicare Supplements, and Prescription Drug Plans, are the 7-month period near your birthday. Preferably prior to the month of your birthday so that everything will start on the 1st of the month that you were born. Every year thereafter, Medicare Advantage and the Prescription Drug plans have open enrollment from October 15 – Dec 7th with the effective date starting Jan 1 of the new year. With Medicare Supplements, you can sign up and end your plan at any time as long as you qualify medically.