Are you confused about your Medicare plan options?
Medicare Advantage, Medicare Supplements, Part C, Part D…
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Should you buy the most expensive plan? Maybe the least expensive plan? Maybe somewhere in the middle?
How do you know which plan is right for you, and what should you look at besides the monthly premium to figure out how much a plan is really going to cost you during the year?
In this video I show you how to compare Medicare Supplement plans with Medicare Advantage plans so you can figure out which type of plan is better for you.
For over 40 years, we’ve been helping our neighbors in the upper Midwest find Medicare plans that best fit their needs without paying too much. When you’re ready to look at specific Medicare plan options in your area, go to bcmwi.com/freeconsultation to sign up for a free, no obligation Medicare consultation with a licensed, experienced broker.
Monthly Costs
The fixed monthly costs for both Medicare Advantage plans and Medicare Supplement plans are the plan monthly premiums. These costs vary widely depending on the plan, and your zip code, and your age.
You can’t decide on a plan just by looking at the monthly plan premium, and here’s why: that monthly premium is not your total out-of-pocket cost for the year.
On the Medicare Advantage side, you need to look at the plan’s deductibles, co-pays, and co-insurance amounts for things like office visits, procedures, tests, and hospitalizations, and pay special attention to the plan’s out-of-pocket maximum amount for the year. Putting all of those together will give you a good idea of how much the plan could potentially cost you during a calendar year.
On the Medicare Supplement side it’s a little different. The deductibles are usually quite low unless you are enrolled in a High Deductible Medicare Supplement. If you are in any plan except Plan N, there are no co-pays, and very few Medicare Supplements have out-of-pocket maximums for the year. In general, your costs for things like going to the doctor, having tests performed, outpatient procedures, and hospitalizations, with a Medicare Supplement are going to be very low.
Medicare Supplements + Part D
One thing to mention though is that Medicare Supplements do not include drug coverage, so when you’re comparing Medicare Advantage plans with Medicare Supplements, on the Medicare Supplement side, it’s important to also include a Medicare Part D prescription drug estimate so that gets added into the true cost of your health care for the year.
If you would prefer to pay a regular, predictable monthly amount and not have to worry about getting bills after a doctor visit, or hospitalization, or surgery, or any procedure, then a Medicare Supplement is probably a better fit for you.
If, however, you would prefer to have generally lower premiums every month, including the possibility of zero dollar premiums, and then just pay for medical services as you use them, so pay for each office visit, ER visit, procedure, hospitalization, then a Medicare Advantage plan might be a better fit for you.
Let’s look at some of the detailed differences between these two types of plans. Or if you’re ready to look at what specific plans are available in your area, reserve your free, no obligation Medicare plan consultation, and get that scheduled with a broker today.
Here are some questions that come up when we are talking to a client about deciding between Medicare Advantage or a Medicare Supplement. The first one: are there provider networks?
With a standard Medicare Supplement, you are allowed to see any provider who accepts Medicare. Medicare Supplement Med-Select plans are available in certain areas, and they offer lower premiums in exchange for using network hospitals for all non-emergency inpatient care. With many Med-Select plans, you are free to see any doctor who accepts Medicare for any outpatient care, though some do require using outpatient networks.
Medicare Advantage plans, on the other hand, do require that you use their network of providers. Some Medicare Advantage plans do provide limited coverage for use of out-of-network providers.
The next question that comes up is: do I need referrals?
With a standard Medicare Supplement, you do not need referrals.
With a Medicare Advantage plan, you might need referrals. It depends on the specifics of the plan, and those do vary from company to company and even from plan to plan within a company.
The next question: how are claims processed?
With Original Medicare and a Medicare Supplement, all claim determinations are made by Medicare itself. If Medicare approves a charge, the Medicare Supplement company has to pay it. A Medicare Supplement company is not allowed to dispute a charge that was approved by Medicare.
Medicare Advantage claims are all processed by the Medicare Advantage insurance company. Although Medicare Advantage companies must by law have coverage that’s equal to or better than Original Medicare Parts A and B, it doesn’t mean that they have to structure it exactly the same as Original Medicare coverage, so it’s very important that you read through your Summary of Benefits before you enroll in a Medicare Advantage plan, so that you understand what is covered and how it is covered.
Are the benefits the same from one plan to another?
Medicare Supplement coverage is standardized by law. That means that if you choose a certain level of coverage, and in most states that means a lettered plan, somewhere between A and N, that coverage will be the same from every company in this state. For example, a Plan G from one company will have exactly the same coverage and benefits as a Plan G from another company. Even though the coverage is identical, the underwriting criteria and the premiums are very, very different from company to company, so it is important to comparison shop.
Medicare Advantage plans are different in the coverage that they provide, the network of providers, and their costs, both fixed costs like monthly premium, and the out-of-pocket maximum cost. Like every other type of Medicare plan, it is important to compare Medicare Advantage plans in a holistic way to really understand the differences when you are trying to decide on the best plan for you.
The next question is: when can I enroll?
Medicare Supplements are month-to-month contracts that accept enrollments at any time during the year. Most will require an applicant who does not have a guaranteed issue right and is not in his or her first six months on Medicare Part B to answer health questions, and then the application will either be accepted or declined, depending on the answers to those health questions.
Medicare Advantage plans are available for enrollment during your Initial Coverage Election Period, which is the time surrounding when you initially started on Medicare, and then every year between October 15th and December 7th. Occasionally, there are also other Special Election Periods that occur when a person is able to change, drop, or add Medicare Advantage plan coverage.
Those are the basic differences between Medicare Supplements and Medicare Advantage plans, which are the two tracks that most people have to decide between when they are starting on Medicare, or if their situation changes and they’re looking to switch from a Medicare Advantage to a Medicare Supplement or the other way around.
It happens all the time, and that’s what we’re here to help with. So if you have any questions and would like assistance immediately, please feel free to call 877-312-1414. Otherwise, reserve your free, no obligation Medicare plan consultation today or watch our free online video to learn more about how to find the best Medicare coverage for you. Our services are always free, and the time you spend talking to us may end up saving you quite a bit of money!
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