When choosing how to get your Medicare Health plan coverage, it really comes down to two options. Both options are popular for different reasons and it's important to understand what they offer and how they differ before making the choice that best meets your needs.
The first option is to keep Original Medicare and then add either or both a Medicare Supplement (Medigap) policy and a Part D prescription drug plan. This option is popular because it offers the widest access to providers and hospitals and it doesn't require you to stay within in particular network. It also allows you to see any provider you wish that accepts Medicare without the need of a referral from your Primary Care Physician (PCP).
Medicare Supplement plans are standardized by the Federal government which means that the plan benefits are identical regardless of which insurance company you choose to go with. Note that Massachusetts, Maine, and Wisconsin have different plans than the standardized plans. Your Medicare Supplement plan works wherever you travel in the United States and because Medicare is your primary insurance, coverage decisions are made by Medicare and not by the supplement company you choose. To put it more simply, if Medicare pays for your service, your supplement company must pay their part.
Part D prescription drug plans are separate plans that help you with the costs of prescription medications you obtain from a pharmacy or through mail order. These plans are all contracted through CMS (Center for Medicare & Medicaid Services) and must offer benefits that are at least as good as the standards set forth each year by CMS. Part D is not offered directly through Medicare like Parts A and B, but rather only through private insurance companies that manage these plans.
The second option is to take a Medicare Advantage Part C plan that combines the Part A and Part B benefits offered by Original Medicare with extra benefits not available with Original Medicare. These plans often includes the Part D prescription drug benefits as well.
Medicare Advantage plans frequently offer a lower monthly premium than Medicare Supplement plans for the benefits they provide. The private insurance company's plan you select will pay your Part A and Part B benefits instead of going through Original Medicare and they usually offer Part D prescription drug coverage as part of the plan. Some common extra benefits offered may include access to fitness centers, meals following a stay in the hospital, transportation to and from medical appointments, and some dental, vision, and hearing coverage. Not all plans offer extra benefits and not all plans offer the same extra benefits. Be sure to read read over your plan options carefully and select the one that best meets your needs.
While these plans often offer a lower premium, they generally have co-payments and co-insurance as out of pocket costs for you to pay as you receive services from hospitals and healthcare providers. It is very comparable to the group and individual policies you had before getting Medicare. They all have a maximum out-of-pocket feature that limits what you would be responsible for in a calendar year which Medicare by itself, does not have.
That's the question I get asked most often, but it really comes down to your needs. You can't have both a Medicare Supplement plan and a Medicare Advantage plan, so I'll be happy to explain how each work in detail so that you can make an informed decision. You're not stuck with the decision you make either. If you like, you have the opportunity every year to change from one type to the other during the AEP (Annual Enrollment Period) from October 15 through December 7th. The AEP also applies to making changes to your Part D prescription drug plan. Medicare Supplement plans can be changed from one company to another throughout the year, but with a few exceptions, you'll be on your Medicare Advantage plan for the entire calendar year.
If you're turning 65 in the next year, chances are you've already started to get a bunch of mail and your phone may be ringing off the hook with companies and agents from all over the country trying to get your business. I prefer to take a more personalized approach and educate you on how Medicare works and go over all of the options available to you. The best way to figure this out is to ask me questions and get answers that make sense to you.
I can meet in-person, via the phone, or even via video-conference with my laptop and your internet-connected computer, smartphone or tablet. Simply fill out the form below and I'll be in touch to schedule a time to review your options, answer your questions, and hopefully make this all seem easier to understand. Or if you prefer, you can call me directly at 309-696-7933.
Let's take a deeper look at Medicare Supplement Insurance and Part D prescription drug plans.
Let's dive into Medicare Advantage plans to see how they work.
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