Medicare

Before choosing a plan we want to be sure you know the difference between your many options. In particular how Medigap-Medicare Supplement Insurance Plans differ from MA-Medicare Advantage Plans. Many people sign up for MA Plans thinking they are Medigap Plans, they are different.

To apply for a Medigap Plan or a MA plan you have to be eligible for Medicare Part A & enrolled in and paying your Part B premium.

Medigap-Medicare Supplement Insurance Plans-Med-Supps

A Medigap plan can only be used in conjunction with original Medicare A & B. Most any medical provider that accepts Medicare will also accept most Medigap Plans, because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered charges) and then sends the remainder (the 20%) to the Medigap Plan Company which pays their part. These plans are also known as Med-Supp plans. Currently there are 10 Standardized Med-Supp plans available: Plan A, B, C, D, F, G, K, L, M, & N.

Medigap-MedSupp Plans usually do not change year-to-year. There are monthly premiums for MedSupp plans and although the monthly cost does generally creep up with age, the coverage only changes to match any changes the government makes to deductibles and copays under Part A & B.

NOTE: For consumers that turn 65 after Jan 1st, 2020, Plans C & F will no longer be available to cover the Part B deductible.

It is important to note that Medigap Plans DO NOT include Rx coverage. You will need to enroll in a stand alone PDP-Prescription Drug Plan (Part D) to have RX coverage. If you do not enroll in a PDP when first eligible you might not be able to get one until the following January 1st and there will be a monthly LEP-Late Enrollment Penalty assessed of approximately $.38/mo times the number of months you could have had Part D coverage. This is a life-time penalty. (There are exceptions to this, such as low-income)

MA-Medicare Advantage-Part C Plans

A MA plan works differently than a Medigap Plan. With MA Plans, such as a HMOs or PPOs, a private insurance company (that you choose) is paid a flat dollar amount each month from Medicare (the federal government) and now the private insurance company is responsible for paying all your Part A & Part B covered charges. You don't lose Medicare but Medicare is no longer paying your claims, because Medicare has paid a private insurance company and they are responsible for paying your claims. These plans follow a very similar type of benefits model as many group plans and most MA plans include extra benefits not covered by original Medicare, such as routine Dental, Hearing and Vision. Some MA plans, like PPOs, have additional monthly premiums, but there are several MA Plans that have a $0 monthly premium.

With MA plans it is important to remember a few things:

First, even though most MA Plans have large Provider Networks, you still may want to check that your Doctor, Hospital, and auxiliary care are in-network. (otherwise you will be paying higher costs and possibly be responsible for 100% of costs out of the network)

Second, MA Plans have co-pays associated with them. Even though most routine services have low copays, others like Hospital stays and Cancer treatments are higher. But there are Hospital Indemnity supplemental plans that will cover your Hospital stay and Cancer copays. Make sure to ask your agent about Indemnity Plans.

Third, most MA Plans include Part D Rx coverage at no extra cost, which is a nice bonus. You should be aware though, if you switch to a Medigap Plan from a MA Plan you will also need to add a stand alone PDP-Part D plan. (there are types of MA Plans that do NOT have Part D Rx coverage built in, so this is something you need to keep in mind when choosing a plan).

Lastly, most MA Plans have extra benefits not covered by original Medicare or Medigap plans. These benefits vary between MA plans but typically include free Health Club membership, Hospital after care meals, Hearing aids and OTC-Over the counter items allowance.

Also, not all Part D-PDPs are the same. Although they are required to be at least as good as the benchmark Medicare model they can vary in costs, copays and specific drugs that are covered. It is important to check which one covers your drugs and continue to check each year because PDPs (like MA Plans) can change year-to-year.

Because these plans can vary even county to county, we strongly recommend that you consult with an independent insurance agent to help you choose the one that best fits your needs. There are no additional fees for using an agent. Professional guidance is available at no cost to you.