Medicare Supplemental vs Medicare Advantage Plans

Medicare Supplemental

Medicare Supplement policies are designed to cover the “gaps” in coverage left by original Medicare.  These gaps include deductibles, coinsurance, co pays and extended hospital stays to name just a few. In an effort to make decisions easier for seniors the federal government standardized Medicare supplement plans.  The standardization makes every Medicare supplement’s benefits the same regardless of which company you purchase from.

Medicare supplements work in conjunction with Medicare Parts A and B.  When a doctor or hospital submits a bill, Medicare will approve (some of it) and pay its part. After that, the supplement will pick up whatever portion of the bill it was designed to pick up. Next, the insured is responsible for the balance, if any.  A good supplement will pick up all of the deductibles and most, if not all, of the coinsurance or co-payments.

Why you should buy Medicare Supplemental

If you have Medicare Supplemental you do not need for a referral to see a doctor or specialist. The doctors generally don’t deal with the Medicare Supplement Company, they submit their claims to Medicare, Medicare pays their part, and then Medicare sends the balance to the Medicare Supplement Company to “Pay the Rest.”

There are generally no co-pays when services are rendered.

Medicare Supplement Policies are “Guaranteed Renewable”. As long as you continue to make the premium payments, you can never lose the coverage.

If you move to another city or state, your Medicare Supplement policy moves with you.

When You should not buy Medicare Supplemental

One problem with supplements are the plan’s premiums. The premiums on a supplement can be expensive, especially for someone in good or near good health. Medicare beneficiaries in poor health or are regularly hospitalized can benefit greatly from supplements. However, paying those premiums may not be worth it for those seeing a doctor only a few times a year or only carry the insurance in case they may need it. 

Medicare Advantage Plans

Under the Medicare Advantage program, the private managed-care version of Medicare, the government pays health plans monthly amounts for every member they cover, and those taxpayer-funded payments are adjusted based on how sick someone is. Members who have more chronic conditions have higher risk scores, and plans that cover them therefore receive higher payments.

Medicare Advantage Plans work in place of Medicare. Types of Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organization (PPOs), and Private Fee-for- Service Plan (PFFS). Deductibles, co-pays, and additional premiums may be required for certain services and not all doctors are covered as “in network.” You typically choose your doctor from a network.

Medicare Advantage plans are a popular option for those over 65, with more than a quarter of all Medicare beneficiaries signing up for the privately-run plans. By choosing a Medicare Advantage plan, eligible participants can often get all their Medicare coverage, including Part A hospital care, Part B medical services, and Part D prescription drug coverage, in a single policy from a private insurance company.

Many Medicare Advantage plans are designed to provide more complete coverage than traditional Medicare, resulting in fewer upfront costs for healthcare expenses. This feature allows Medicare Advantage participants to avoid having to get separate supplemental Medicare coverage, also known as Medigap policies, in order to reimburse expenses that traditional Medicare won’t pay.

Medicare Advantage plans available to you in your state may be more restrictive than you’re used to or than you prefer when it comes to seeing doctors.

This downside might have you rethinking Medicare Advantage plans, but don’t dismiss them without seeing just what kinds of plans are available to you and what they offer.

How to shop around for Medicare Plans?

You should always be checking your benefits every year because the slightest change can have very big impacts.

Is it enough to shop on premium alone? The answer is no, you need to get an advice form a Medicare Specialist and it is a free service seniors get.

Open enrollment began Oct. 15. You have until Dec. 7 to decide if you want: an Advantage plan with or without a prescription benefit; a stand-alone drug coverage plan; or traditional Medicare managed by the federal government. Your selected coverage goes into effect Jan. 1.

Where contact a Medicare Specialist?

You can call us at Call Us 813 964 7100

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Schedule a complimentary meeting to review and save your Medicare  plan calling at Call Us  813 964 7100