Most individuals eligible for Medicare understand that they need something in addition to Medicare but don’t really know why. For those who need clarification on what Medicare covers or more importantly what it does not cover please click here
We speak to two types of people on a daily basis: Those who have done their research and have only a few questions; and those who are frustrated and completely overwhelmed with all aspects pertaining to Medicare and plan choices. Wherever you are in the process, understanding your two options are the most important pieces of the Medicare puzzle.
Option 1: Medicare Supplement / Medigap
A Medicare Supplement Insurance policy is a Secondary Payer. It pays some or all of the remaining balance after Medicare pays their portion. All Medicare Supplements are standardized offering plans A, B, C, D, F, G, K, L, M, and N. This means the coverage and benefits are the same from company to company. There is no difference in coverage between one company’s plan F and another company’s plan F. The only difference is the name on the card and the monthly premium being charged.
|Benefits||Plan A||Plan B||Plan C||Plan D||Plan F||Plan G||Plan K||Plan L||Plan M||Plan N|
|Part A hospital coinsurance (20%) and 365 extra hospital days||100%||100%||100%||100%||100%||100%||100%||100%||100%||100%|
|Part A deductible||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Part B coinsurance (20%)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%
|Part B deductible||100%||100%|
|Part B excess charges||100%||100%|
|Blood (first 3 pints)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Yearly Out of Pocket Limit (2012)||No Limit||No Limit||No Limit||No Limit||No Limit||No Limit||$4,660||$2,330||No Limit||No Limit|
Option 2: Medicare Advantage Plan / Part C
Medicare Advantage plans are a low cost alternative to Medicare Supplements and are available with little to no monthly premiums. They are offered by private insurance company’s and approved by Medicare. Medicare Advantage members are still in Medicare and continue to keep the same rights and protections as Medicare. As a member in a Medicare Advantage plan you will continue to receive regular Medicare covered services. In addition, members may also have access to additional services not covered by Medicare such as vision, hearing, dental and/or health and wellness programs. Prescription drug plans often are included in the Medicare Advantage plan while Supplemental policy holders must pay extra for the Part D prescription plan.
|Medicare Advantage||Little to No Monthly Premium.
Low and Predictable Co-Pays.
Provide Maximum Out of Pocket Coverage (Catastrophic).
Offer Additional Benefits including Vision, Dental & Hearing.
|Plans can change Year to Year.
Plans use Networks; you will be encouraged to use Plan Providers or pay higher co-pays.
On rare occasions you may run into a Doctor that may not accept Medicare Advantage Plans.
How can Medicare Advantage Plans can costs so little? Medicare pays a fixed amount for your care every month to the company’s offering Medicare Advantage Plans. These company’s must follow rules set by Medicare. However, Medicare Advantage Plans can charge different out-of-pocket costs and have different guidelines for how services are rendered.