Ensuring you have quality health coverage not only allows you to access routine and preventive care, but it helps to protect you financially in the event that you experience a serious illness or catastrophic event. Once you are eligible for Original Medicare, which includes Medicare Part A (inpatient coverage), and Medicare Part B (coverage for other preventive and medically necessary services), you’ll need to decide if you’ll want additional coverage to minimize gaps and ensure comprehensive access to care. Depending on your needs, a Medicare Advantage or Medicare Supplement Plan may help offer you peace of mind and financial protection, along with access to quality health care services.
Medicare Advantage Plans
Medicare Advantage is also referred to as Medicare Part C. Medicare Advantage plans provide coverage through Medicare-approved private insurance companies for all the services covered by Original Medicare, with the exception of hospice care, which is only covered under Medicare part A. As the plans are provided by private insurance companies, there are a variety of coverage levels, network structures, and tier options available. Depending on the option you choose, your plan may cover dental and vision care, and some prescription drugs as well.
Comparing Medicare Advantage Plans
When choosing a Medicare Advantage Plan, you will need to decide which plan will best suite your needs. When comparing Medicare Advantage plans, consider the following:
- What is the plan’s star rating? Each Medicare Advantage plan is rated on a scale of one to five, with five being the highest quality rating.
- Are your current health care providers (doctors, physicians, hospitals, specialists, etc.) considered in-network providers?
- Can you afford the monthly premium? Some plans offer $0 in premiums, but remember you may still need to pay your Part B premium and out-of-pocket costs.
- Can you afford the annual deductible? Would you prefer paying a higher premium so that if you need care, you will pay less out-of-pocket in deductible costs?
- Are services that you anticipate needing covered benefits?
- What are the out-of-pocket limits before coverage is paid at 100 percent? Can you afford to pay that maximum amount if necessary?
- If you anticipate needing vision, dental, and/or hearing coverage, are they included?
- Are prescription drugs covered? Are your current medications covered under the drug formulary (a list of approved prescription medications)? What out-of-pocket costs will you be subject to for prescription drugs?
Medicare Supplement Plans
Medicare Supplement is also known as a Medigap plan. Like Medicare Advantage, Medicare Supplement plans are offered by private insurance companies. Unlike Medicare Advantage, Medicare Supplement plans cover services that are not covered by Original Medicare. Medicare Supplement plans can also help you to pay for out-of-pocket costs such as deductibles, copayment, and your Medicare Plan Part B premiums.
Unlike Medicare Advantage, Medicare Supplement plans do not offer prescription drug coverage. If you choose a Medicare Supplement plan, but anticipate also needing prescription drug coverage, you may need to purchase an additional Medicare Part D, or drug coverage, plan. Also unlike Medicare Advantage, Medicare Supplement plans do not cover dental or vision care.
Comparing Medicare Supplement Plans
For Medicare Supplement Plans, there are 10 standardized plans available in 47 states. The three remaining states, Massachusetts, Minnesota, and Wisconsin, have their own plan offerings. Medicare Supplement plans are noted with letters from A through N. Even though benefits are standardized across most Medicare Supplement plans, your out-of-pocket costs, including premiums, may vary.
What follows is a partial summary of some of the differences between plan types. Click here to view more information.
Note: Remember that the chart below does not apply if you live in MA, MN or WI. The information below was obtained by Medicare.gov, however plans are subject to change. Contact us to confirm benefit options and determine which plan is right for you.
Medicare Supplement Plans
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Part B coinsurance or copayment||Y||Y||Y||Y||Y||Y||50%||75%||Y||Y**|
|Part A hospice care coinsurance or copayment||Y||Y||Y||Y||Y||Y||50%||75%||Y||Y|
|Skilled Nursing Care Coinsurance||N||N||Y||Y||Y||Y||50%||75%||Y||Y|
|Part A Deductible||N||Y||Y||Y||Y||Y||50%||75%||50%||Y|
|Part B Deductible||N||N||Y||N||Y||N||N||N||N||N|
* Plan F also offers a high-deductible option in which you must pay for Medicare-covered costs up to the deductible amount of $2,200 in 2017 before your Medicare Supplement plan pays for any costs.
**Except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.
Medicare Coverage Helpline Reviews
Make sure that when seeking guidance and enrollment support, that you choose a verified Medicare agent in your state. There are a variety of entities claiming to offer telephone support, but investigation into such Medicare Coverage Helpline Reviews often proves that the services are not actually offered by licensed, reputable Medicare Agents.
Call Us for Medicare Guidance and Enrollment Assistance
For more information on Medicare coverage, or for guidance choosing a Medicare Advantage Plan, or Medicare Supplement Plan, call us today. Our Licensed Medicare Advisors are available to help you. We will work with you one-on-one to help you assess your needs and determine which plan will help ensure you maintain affordable, comprehensive health coverage.
Use our Medicare Plan Finder to speak to a licensed agent and compare Medicare Advantage and Medicare Supplement Plans to find your best coverage option.