When it comes to paying for health care services for those who are age 65 and over, there are several options that people can choose from – which includes having coverage through Medicare.
Medicare provides health insurance coverage for people who are 65 and older, as well as for certain individuals who are younger than age 65 and who receive this coverage due to a qualifying disability.
There are four key “parts” to Medicare services. These include:
- Medicare Part A – Hospitalization
- Medicare Part B – Medical / Doctors’ Services
- Medicare Part C – Medicare Advantage
- Medicare Part D – Prescription Drug Coverage
While having health care coverage through Medicare can provide you with a wide range of coverage, what many people may not realize is that you could still be left with large out-of-pocket expenses such as copayments, coinsurance, and/or deductibles. And, depending on how often you need medical services, these costs can add up to be a substantial figure, which could, in turn, affect your income and assets in retirement.
How Medicare Supplement And Medicare Advantage Differ
Even they have very similar sounding names, Medicare Supplement and Medicare Advantage are two completely different entities. Having a good understanding of what each of these entities is, as well as if or when you should use them, can help you in lowering your out-of-pocket costs for the health care services that you require.
Medicare Supplement (Medigap)
Medicare Supplement insurance is a type of coverage that is specifically designed for covering the costs that are not provided for by Medicare Part A and Part B – which is also referred to as “Original Medicare.” Because this coverage can fill in many of Medicare’s “gaps,” Medicare Supplement insurance is often referred to as Medigap.
Today, there are ten different Medigap Plans that you can choose from – each named after a different letter of the alphabet. Medicare Supplement Plan A offers a set of basic core benefits, while the other Medigap plans provide these and other coverages.
With Medicare Supplement Plan A, the following benefits are offered:
- Part A coinsurance and hospitalization costs – for one additional year after original Medicare coverage is used
- Part B coinsurance or copayment amount
- The first 3 pints of blood each year
- Part A hospice care coinsurance or copayment
Other Medicare Supplement plans will provide the core benefits of Plan A, along with various other benefits, which may include:
- Skilled nursing facility care coinsurance
- Medicare Part A deductible amount
- Medicare Part B deductible amount
- Medicare Part B excess charge
- Foreign travel exchange coverage – up to the plan’s limit
- Out-of-pocket limit (For instance, when a Medicare Supplement insurance policyholder meets his or her yearly out-of-pocket limit and their yearly Part B deductible, the Medicare Supplement insurance plan will pay 100 percent of covered services for the remainder of the calendar year).
Note: If an individual lives in Massachusetts, Minnesota, or Wisconsin, the Medicare Supplement insurance policies are standardized in a different way.
While Medicare Supplement insurance plans can help with filling in the gaps in Medicare’s coverage, these policies are not offered directly by Medicare, but rather by private insurance companies. Therefore, even though the coverage that is offered by each plan of the same letter must be the same, the premiums can differ – sometimes substantially – from one insurance company to another. With that in mind, it is important to compare policies, insurance carriers, and premium rates before you move forward with purchasing a Medicare Supplement insurance plan.
If you covered under Original Medicare (Medicare Part A and Part B), you are eligible to also apply for a Medicare Supplement insurance plan. If, however, you have Medicare Advantage – also known as Medicare Part C – you cannot.
Medicare Advantage Plans (Medicare Part C)
Medicare Advantage is an alternate way of receiving your Medicare Part A and B benefits. If you choose Medicare Part C / Medicare Advantage, you will still receive all of your Medicare Part A Hospital Insurance and your Medicare Part B Medical Insurance benefits.
Typically, however, Medicare Advantage plans will also offer additional coverage that is not included with Medicare Parts A and B. For example, many Medicare Advantage plans offer coverage for vision, dental, and or hearing, as well as for wellness care. In addition, many Medicare Advantage plans may also automatically include Medicare Part D prescription drug benefits.
There are several different types of Medicare Advantage plans. These include the following:
HMO (Health Maintenance Organization)
With most HMO plans, you are only allowed to see doctors and other health care providers – including hospitals – that are in the plan’s network. (Unless you have an emergency or urgent health care need). It is also likely that you will need a referral from your primary care provider to visit other medical professionals and/or specialists.
PPO (Preferred Provider Organization)
With a Preferred Provider Organization, you will pay less regarding coinsurance/copayments/deductibles if you use the medical providers that are listed in the plan’s network.
PFFS (Private Fee for Service)
Private fee for service Medicare Advantage plans operates in a similar manner as Original Medicare. This means that you can typically see any doctor or healthcare provider, as well as go to any hospital, provided that the provider accepts the payment terms of your plan. In this type of arrangement, the plan will determine how much it will pay the medical providers, as well as how much you are required to pay when you receive care.
SNP (Special Needs Plan)
A Medicare Advantage Special Needs Plan is focused on providing specialized care for certain groups of individuals, such as those who live in a skilled nursing facility and/or those who may have certain types of chronic health conditions.
HMOPOS (HMO Point of Service)
With an HMO point of service plan, you may be able to receive some of your health care services out-of-network in exchange for paying a higher amount of copayment or coinsurance.
Just like Medicare Supplement insurance, Medicare Advantage plans are sold by private insurance carriers, and not through Medicare directly. Therefore, there can be many different plan offerings to choose from, depending on the insurance carrier that you choose, as well as the plan you purchase. Also, the premiums that are charged for Medicare Advantage can differ – sometimes significantly – from one insurance carrier to another. Because of that, if you choose to go the route of Medicare Advantage, it will be essential to have a thorough understanding of the coverage you are purchasing and its monthly premium.
One way to help yourself to ensure that you are getting a Medicare Advantage plan that is right for you is to work in conjunction with an independent insurance agency or brokerage that offers numerous different plans. That way, you will be better able to directly compare the benefits, policies, and the premium charged – and from there, you can make the decision as to which one is best for you and your anticipated health care needs.
Should You Consider A Medicare Advantage Plan?
In certain instances, a Medicare Advantage plan may be beneficial. For example, if you are seeking more care coverage than what Original Medicare offers – such as benefits for dental, vision, and/or hearing – then a Medicare Advantage plan may be right for you.
When Should You Look For Medicare Supplement Insurance Coverage?
If you are enrolled in Medicare Parts A and B (Original Medicare), but you are worried about paying high out-of-pocket costs such as deductibles, coinsurance and/or copayments, then a Medicare Supplement plan may be a good option for you. Because there are many Medicare Supplement insurance plans to choose from, you can help to keep your premium costs down by going with one that just offers a basic set of benefits, or alternatively, you could opt for a more comprehensive Medigap plan that provides a much broader array of coverage.
How To Find The Best Rates On Medicare Supplement And Medicare Advantage
You can directly shop and compare in an unbiased manner by using our quoting tool or by reaching out to us, an independent insurance agency. We have access to many carriers that offer supplement or advantage plans and no doubt we will work to get you the best rate.
For any additional questions that you may have, please feel free to contact us via phone, toll-free, at 864-332-4209. Although there are many variables to consider in conjunction with your Medicare coverage, the good news is that our experts can lead you to the plan that fits your needs the best. So, contact us today – we’re here to help.