Comparing Medicare Supplemental Options
Now that you are enrolled in Parts A and B you should analyze your options for Medicare Insurance. Basically you have two options, a Medicare Supplement or a Medicare Advantage plan.
Below is a general comparison chart for these two types of medicare insurance. Each one has it’s pros and cons. Take a look at this chart and see if one is more compelling for you.
|Eligibility||Must be enrolled in Medicare Part A and B. All applicants must be accepted during Medigap Open Enrollement and Guaranteed Issue Periods. Outside of this time insurance carriers can deny coverage and rate up the premiums||Must be enrolled in Medicare Part A and B and live in the service area of the provider. Can enroll when first enrolled in Medicare, otherwise enrollment is during Annual Enrollment Period (Oct 15th - Dec 7th). All applicants are accepted unless they have End Stage Renal Disease.|
|What are the premiums?||Premiums range from $90 - $200 depending on age, health, tobacco use, location, and plan chosen.||$0 to more than $100 a month depending on the plan. All plan enrollees pay the same regardless of age or health history.|
|What are the Out of Pocket costs?||Plan F offers 100% medical coverage.|
Plan G covers 100% as well with the exception of your annual Part B deductible which is $147.
|In-network medical deductibles and copays of up to $3,400 to $6,700 a year, depending on the plan and carrier. Out of network exposure can be unlimited depending on the plan.|
|Healthcare Provider Options||There is NO network. As long as your provider accepts Medicare they accept the plan regardless of the carrier. No referrals for specialist required.||HMOs and PPOs are the most common provider networks.|
HMO: Generally in-network coverage only. Will need referrals from primary provider for specialists.
PPO: No referrals needed. Covers out of network. Plans have higher premiums but offer more flexibility.
|When can you buy?||First six months after you sign up for Part B and are at least 65 years old. After that, in most states you can be turned down or charged extra for pre-existing conditions. You can change mid year if the new company approves you.||When you first enroll in both Medicare A and B and annually thereafter during Annual Enrollment (Oct. 15-Dec. 7). Can change mid year if you qualify for a Special Enrollment Period.|
|Are prescriptions covered?||Prescriptions are not covered. |
You can enroll in any PDP (Part D - Prescription Drug Plan) of your choice.
We will assist you in choosing your Part D plan.
|Prescription coverage is most often included but you must make sure that it is a MA-PD (Medicare Advantage Prescription Drug) plan. Some carriers offer Medical only coverage.|
Very important to make sure that your prescriptions are covered under the formulary (and how much will they cost you?) before finalizing this coverage.
|What cards are in my wallet?||Usually 3 cards:|
1. Red, white and blue Medicare Card.
2. Medicare Supplement card
3. Part D card
|Usually just one Medicare Advantage card. The red, white, and blue Medicare card can stay in your desk drawer.|
|Which one is best for me?||Don't want to deal with copays and coinsurance amounts. Like the idea of having 100% coverage (Plan F) for Medicare approved claims, giving you $0 out of pocket exposure.|
This plan is ideal for people that travel often, live near a state line and may seek care across the state line, or may live in another state for a period of time throughout the year.
Choice of any doctor anywhere you want (as long as they accept Medicare).
|Main goal is to save on monthly premiums and understand the out of pocket exposure of the plan.|
If you don't live elsewhere during portions of the year and have access to doctors in the HMO or PPO.
Want a "packaged plan" that includes both medical and prescription coverage.
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