While Original Medicare (Part A and Part B) goes a long way in providing quality health insurance coverage, sometimes it isn’t quite enough. Enrollees may find that Original Medicare does not cover the cost of their vision and dental care, or prescription drugs. Copayments and deductibles for covered healthcare expenses can quickly add up.
Whether you are new to Medicare or are experiencing the high out of pocket costs that can sometimes occur, it is wise to consider a Medicare Supplement (Medigap) or Medicare Advantage (Part C) plan. These plans work alongside or in place of Original Medicare to more completely cover your healthcare expenses. They do this, however, in very different ways.
Medigap plans work to supplement the coverage already provided by Original Medicare. Advantage plans, on the other hand, take its place almost entirely. Because of this, it is not possible to hold both Medigap and Medicare Advantage coverage.
Purchasing a Medigap plan requires that you stay enrolled in Original Medicare. Many people who choose to add a Medicare Supplement plan also still have an unmet need for prescription drug coverage. For these individuals, adding in a Part D plan to cover that expense is also necessary.
Choosing Medicare Advantage coverage means you do not have to enroll in multiple separate plans for your health insurance. These plans include all the benefits of Original Medicare, plus additional coverage options. In this way, Advantage plans can function as an all-in-one solution for a lot of people.
Medigap coverage comes in a relatively wide range of choices. All the supplemental plans Medicare offers are given standardized letter designations. All plans with the same letter offer the same types and levels of coverage regardless of the insurance carrier who is offering the plan. Medigap plans do not generally include vision or dental coverage.
Because they are less tied to Original Medicare, Medicare Advantage plans have a lot more variety when it comes to the kinds of coverage they offer. Unlike Medigap coverage, Advantage plan specifics are not consistent across insurance companies. Many do, though, include Part D prescription and drug coverage, as well as vision and dental coverage.
Medicare Supplement plans are accepted anywhere Original Medicare is. Supplemental plans are sold by individual insurance companies, but have the consistency of being standardized by Medicare proper. This allows healthcare providers to have acknowledge of what they can expect from the insurance company when they see a patient covered by a Medigap plan.
Depending on the type of Medicare Advantage plan that you choose, your options for a healthcare provider may be somewhat limited. It is important to be very familiar with the network-related restrictions your specific plan may carry to avoid unexpected costs for your care. Some healthcare providers also restrict the kinds of Advantage plans they accept. This is due in part to the lack of consistency from one plan to another.
Though the coverage of a given Medigap plan is regulated, the monthly cost can vary. Your Medicare Supplement premium is dictated by factors like the carrier you choose and the state in which you live. This premium is added on to your existing Original Medicare premium and any additional insurance you may choose to purchase, like Part D prescription drug coverage.
While some Medicare Advantage plans come with a $0 price tag on their monthly premium, the coverage isn’t exactly “free.” You are still responsible for at least your Medicare Part B premium when you purchase a Medicare Advantage plan. Your Advantage plan premium will be based on the coverage option you select and the carrier you choose. Advantage plans offer the benefit of an upper bound on your out-of-pocket costs which can help mitigate your overall healthcare expenses.
There are so many factors to consider when choosing the Medicare coverage that is right for you, and it can be an overwhelming process. This guide is a great place to start, but we would love to see you at one of our upcoming events or to schedule a free consultation to go over your unique needs. We want to empower you to choose the coverage that is the best for you.
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We are licensed and represent plans and carriers in AZ, CO, IA, KS, MN, MO, NE, SC, SD, TX, and WA. The following disclaimer is for Lancaster county in Nebraska, where we reside.
We do not offer every plan available in your area. Currently we represent 8 organizations which offer 53 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options.Not affiliated with or endorsed by the government or federal Medicare program. Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal. By providing the information above, I grant permission for a licensed insurance agent to contact me regarding my Medicare options including Medicare Supplement, Medicare Advantage, Prescription Drug plans.