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Video: Learn About Medigap Plans
Medicare Supplement Versus Advantage Plans
It used to be pretty simple in the world of Medicare. You had traditional Medicare and supplements. Medicare HMO’s cane on the scene in the 80s and for a while, they did a good job of containing health care costs albeit with restrictions in terms of which doctors you could see and how your care was managed. The lower rates provided an offset to this more restrictive type of coverage and we now had two options to address the inherent holes in traditional Medicare. Medical costs continued to rise at a faster and faster clip and the HMO’s found it difficult to keep pace at a low or no cost means of health insurance. We then had the newest entry in the Medicare supplement insurance ring..Advantage Plans. Advantage plans are the resurrected HMO model plans but with a renewed lifeline and better financial underpinning. Let’s first break down how traditional Medicare supplement and Advantage plans work with Medicare and then we can compare them against each other in regards the beneficiary. We know what Medicare covers and more importantly what it doesn’t cover. Traditional Medicare supplement plans aim to fill in the holes of Traditional Medicare including the deductibles (depending on plan chosen), co-insurance, and various other holes. Keep in mind that Medicare ultimately determines if something is covered and the supplement follows suit. For example, if a certain medical benefit is not covered by Medicare, the supplement will not pay for it either. So, Medicare supplements work as wrap-around plans to Traditional Medicare and you keep the same flexibility in terms of . What about Advantage plans? Advantage plans are all together different. First, they are no or low cost insurance plans. That’s the main reason most people go the Advantage route. They are also going to be more restrictive in terms of access to care as expected with the HMO type model that they generally follow. You generally have primary care doctors or medical groups through which, care is managed. Some Advantage plans may offer more flexibility in terms of referring yourself out but offer a more limited (loosely translated as less expensive) network to operate within when compared with Medicare supplemental insurance plans. Advantage plans may offer more benefits than just core Medicare benefits as well. So how are Advantage plans able to this and more importantly, what’s the best choice for people shopping the market? An interesting question is why the new Advantage plans are able to flourish where the old HMO’s failed? Two reason. First, there is more Federal funding of the Advantage plans on a per capita basis. Secondly, there’s more back-end exposure to the beneficiary (you) and this is critical to really making a good decision. You can’t just look at the premium. For example. An F plan Medigap policy might run a 65 year old $125/monthly. An Advantage plan might be $25monthly. Looking at that, the Advantage plan looks…advantageous but you have to look at the back end. If you have large health bills in a calendar year, the F plan will likely result in very little if no expense out of your pocket. The Advantage plan may have a deductible or out of pocket maximum in the 1000’s of dollars range. The question is this…is it a good wager or bet to assume more risk for larger medical bills in your 60’s, 70’s and beyond? We’re hoping that question answers itself but just in case… a person’s health care costs double with every decades of a person’s life and 90% of a person’s health care costs are generally incurred in the last 12 months of life. The odds of Advantage plans working out for you over the long haul (and we are making a decision for multiple years into the future) are not in your favor. They’re in the carrier’s favor but many people just see the cheap premium at age 65 and jump not seeing the large financial drop just over the edge.
Must a health care provider who accepts Medicare also accept all Medicare supplemental and Advantage plans?
Doctors can accept any form of payment they wish. Usually if a Doctor accepts Medicare they will absolutely accept Medicare supplement plans since it is to their advantage. Medicare Advantage is a different story. If it is a Medicare advantage HMO the Doctor must be in the network to accept. Usually most Doctors who accept Medicare will accept a PPO type plan unless they do not accept any insurance at all. If a doctor will not bill your ppo you can also send a paper claim to your insurance company and they will pay their portion.
Medicare Supplemental Plans
To understand the differences in the plans, you can easily review the coverage chart. NO Medicare supplemental insurance plans cover medications, so that is not listed on the chart at all. The plans do, however, cover things that Medicare covers. The easiest way to think of it is that, if Medicare covers it, the supplemental plan will fill in the “gaps”. But if it is something that Medicare doesn’t cover (i.e. dental, experimental procedures, etc.), the supplemental plan likely will not cover it either.
Medigap Enrollment Steps: #1 Understanding What Medigap Is
When you think about Medigap you shouldn’t compare it to the coverage known as Medicare Advantage because that coverage provides extra benefits beyond Medicare. Medigap insurance simply fills in the gaps that Medicare left behind for you to find a way to fill in. This means if you are in a situation where you use Medicare a lot for medical services you may need the benefits of a Medigap plan.
How to Choose a Medicare Supplemental Plan
When it comes to choosing a Medicare supplemental plan, there are two factors you need to consider: cost of premium and coverage. Supplemental plans are categorized from A to N and the further you go down the categories, the cost of premiums hike up. Plans on the N category have very expensive premiums because of the different types of coverage available, while A plans have affordable premiums with next to basic coverage. The latter plans are very popular among individuals looking forward to save on costs but when you want more coverage such as home care, travel coverage or nursing home care, you would want to carefully consider each plan category.
Medicare Supplement Plans
Start by adding your zip code on the senior Medicare supplements page and compare free quotes from a list of carefully selected insurance companies. We aren’t talking small companies you’ve never heard of …… we are talking AARP Anthem Blue Cross just to name a couple.
Compare Medicare Supplement Plans Side By Side
As you can see, comparing plan benefits from one company to the next is mostly a non-issue. Although some companies such as United Healthcare seem to offer small benefits such as vision and prescription drug discounts, this is actually a benefit of being an AARP member.
Anthem high Deductible F plan Connecticut « Insurance News from Crowe & Associates
Here is how High Deductible F works-(This is a very simplified version but you will get the point): Medicare Part A covers hospital costs after a $1,200 deductible and Medicare Part B covers 80% of doctors and testing costs. The anthem High F, will cover 100% of costs once a consumer spends $2,070. out of pocket in a year. At $35 a month, the math can not be beat. Try the math versus any other Medicare Supplement plan on the market and see how it comes out. Keep in mind that only 1% of Medicare consumers with a high deductible F plan every actually hit their deductible.