Welcome to our first Medicare article! The purpose of this is to provide education regarding many aspects of Medicare –supplements, managed care, prescription drug benefits, changes in the marketplace, our perspective on these topics and more.
Nerdy legal disclaimer – None of this is tailored, personal advice; this is for education and discussion. Call or meet with us to discuss what is right for you. By continuing to read, you accept that we have a sense of humor and occasionally make jokes or poke fun at the insurance industry.
TOPIC 1: Supplements (aka Medigap) vs. Managed Care (aka Medicare Advantage)
This first post is a bit generic, but we must start somewhere! Here goes: We will discuss the many different parts of Medicare on another post but for this one, we will presume that you know your A from your B 😊. After you have qualified and enrolled in Part A & B, you should choose either a supplement or a managed care plan. You are not federally mandated to do so, but you should. You really, really should choose one. What’s the difference you ask? See chart below:
Medicare Supplement vs. Medicare Advantage: Which Is Right For You?
Medicare Supplement
• Monthly payments – Common premium at Age 65: $120-160
• Access to any provider, hospital or supplier who accepts Medicare
• Must be enrolled in Medicare Part A & B
• Policies don’t cover prescription drugs, so you should enroll in Part D separately
• Total out of pocket expenses is the Part B deductible – $240
Medicare Advantage
• Monthly Premium can be $0
• Restricted choice of providers, hospitals and suppliers
• Must be enrolled in Medicare Part A & B
• Most policies include Part D prescription drug coverage
• Total out of pocket expenses are higher – typically $3000-7000
In non-insurance language, here are the major differences. A person enrolled in a SUPPLEMENT will have the flexibility in choosing healthcare providers including primary care doctors, specialists, hospitals and home health care services. So, if Medicare pays, your supplement pays. This plan offers nationwide coverage, so you can visit doctors or hospitals anywhere, even while traveling. So, plan that trip to Napa, Branson or The Villages and have access to care with any facility who accepts Medicare. There is a premium for this policy. Great access to care costs more money. Also, a person should purchase a separate Part D drug card and dental coverage. Got it?
A person enrolled in a MANAGED CARE plan will have access to any doctor, hospital, facility, lab, etc., if the provider is listed in the plan network. You should pay special attention to the network, including any limitations. These premiums are typically low in cost, sometimes even $0. More limited access to care costs less premium but will include additional expenses when using your plan. All benefits are bundled in these plans so there is no need to purchase an additional prescription drug or dental plan.
So, what’s right for you? I don’t know – call us and let’s talk about it. There isn’t a right or wrong. There are pros and cons to both plans. What’s right for me may not be what’s right for you. But you need to do something and that’s where we fit into the equation. We will ask you a bunch of questions about your health, finances, and general life plans to help YOU make the best decision for YOU. Let’s talk soon.
