Medicare Advantage

Medicare Advantage plans play a major role in the marketplace for seniors and individuals on Medicare disability. These plans often have a $0 premium and usually include a prescription drug plan.

Advantage plans replace Original Medicare. They are totally different than Medicare Supplements. These plans are “pay as you need it“ type of plan. Yes, you could have a $0 premium, BUT, you will have co-payments when you receive medical care:

Primary Care Doctor Co-pay, Specialist Co-pay, Hospital Inpatient/day Co-pay, Outpatient Services Co-pay, Skilled Nursing Co-pay, Ambulance Co-pay, Lab work Co-pay, Radiology Co-pay, Durable Medical equipment Co-pay, etc.

These plans have an Annual Out Of Pocket Maximum so you can plan for worst case situations. The out of pocket maximum is usually very high (up to $6700) but you need to look at the different co-pays and determine your likelihood of reaching that large number.

If you are used to traditional health insurance from your employer or individual health plan, these Advantage Plans work similarly. Most Advantage plans have a local network of doctors and hospitals that you must go to. If you are healthy and don’t go to the doctor often, have savings to cover your maximum out of pocket, and don’t mind tracking your healthcare costs, Advantage Plans might be a fit.

Click the tab “Medicare Advantage” for more detail.

Medicare Supplement

Medicare Supplements work in conjunction with Original Medicare. These plans are often called ‘Medi-gap’ plans because they fill in the gaps of Original Medicare. Original Medicare has deductibles and co-insurance, with no maximum out of pocket caps. Just having original Medicare can get very expensive, hence the need for a Medicare Supplement.

Supplement plans do not include any prescription drug coverage. You will need to buy a stand-alone Part D plan, known as a PDP. Click “Prescription Drug Coverage” under Medicare Supplement tab for more detail.

There are 10 standardized supplement plans available for purchase. Most people opt for the F Plan or the G Plan. The F Plan and the G plan have the exact same benefits, except you pay your annual part B deductible ($147 this year) with the G Plan, whereas with an F Plan your supplement company pays your Part B deductible.

There are no networks with Medicare Supplements. You can go to any doctor that accepts Medicare. There are no co-pays, co-insurance, or deductibles for any Medicare Supplement except for the N Plan. When you go to the doctor or hospital, your bills are paid first by Medicare and then by your supplement company and you will owe nothing.

My father-in-law fought cancer for 5 years. He was in multiple hospitals (including Duke) and received treatment from many doctors. He never paid anything except his monthly premium!

If you travel often . . . don’t mind paying a premium . . . don’t want the inconvenience of networks . . . a Medicare Supplement could be the right choice for you.

Click the tab “Medicare Supplement” for more detail.

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