I get this question all the time:
What about Medicare Advantage plans?
Is it too good to be true?
Maybe, Maybe Not!
Medicare Advantage
Let me 1st say this: Medicare Advantage plans have their place. They can work for some. While for others, not so much!
Medicare Advantage plans take the place of original Medicare. You continue to pay your Part B premium, while the claims are paid by the Medicare Advantage plan.
The “advantage” to Medicare Advantage is low or zero cost premium. How do they have a zero cost plan? Remember you have to continue to pay your part B premium. That premium is essentially forwarded to the Medicare Advantage carrier since they are accepting you as a risk. Some other perks including Prescription drug coverage are often included. Plans often offer dental and vision (an additional charge).
Now lets look at the disadvantages.
They have networks. In-network and out-of-network. Typically in rural areas, in-network can be limited to the county in which you live.
If you travel out of state, you can be covered for emergency care but much of the cost falls on you.
Some specialist are not in-network with the plan.
You may get a plan with all your doctor’s in-network but the Rx coverage might have some drugs outside formularies that otherwise, would have been covered another carrier’s drug plan.
Who benefits the most from Medicare Advantage plans? Healthy individuals. If you do not anticipate many medical claims, you can save on premiums. Works great especially with doctors in-network since many have a $0-$20 copay.
Limited budget or use VA? Medicare Advantage might be right for you. In these situations, Medicare Advantage might be a route to consider. You can save money on premiums….but have something to prevent catastrophic losLastly, there are some great Medicare Advantage plans that work well for those people that have VA benefits. Medicare Advantage plans offer protection if you prefer a doctor outside of the VA or for added peace of mind.
Medicare supplement:
Simply put, Medicare supplements (sometimes referred to as Medi-gap) supplement or fill in the gaps for the deductibles or copays not covered by Medicare. You must be enrolled in Part B.
Medicare supplements are regulated by both Federal government (Medicare is a federal program) and State governments (Insurance is regulated by the state). If Medicare pays, the supplement pays! No questions ask.
I get a few calls a month regarding this. Often times, sometimes while people are at the doctor’s office. Beau, standing here at the doctor’s office and they are getting ready to do (insert procedure). Is the supplement going to pay?
Always the same response. Well, did you give them your Medicare card? Yes. Did you hand them your supplement card? Yes.
Answer: Mr Smith, if Medicare pays the supplement is required by Federal Law (CMMS) to pay.
If it says Standardized Medicare Supplement on the policy, it is accepted.
When I recommend a carrier sometimes I will get the question, “well let me call my doctor to see if they accept XYZ insurance”.
There is no need to worry.
Hospital and Doctor claims are filed with Medicare directly. From there Medicare sends what is known as a “Medicare slip” which goes to the insurance carrier. From there it shows what Medicare paid (or didn’t pay), and the supplement pays the balance- no ifs, ands, buts about it.
No worries about additional out of pocket cost!
The disadvantages:
You pay a monthly premium for the plan.
At renewal, premiums often (will) go up.
As many of you know, I contact you every year with lower options.
You must enroll in a stand-along RX plan at an additional cost. Well, this is a positive and a negative. The positive is that you know you are getting the very best RX coverage based on your prescriptions. The downside is that you pay a premium for it (they premium can be deducted for your Social Security)…. most premiums range from $15-$30/month.
Which is right for you? Have more questions or would like to look further into either plan? Call me today.
When I recommend a carrier sometimes I will get the question, “well let me call my doctor to see if they accept XYZ insurance”
There is no need to worry.
Hospital and Doctor claims are filed with Medicare directly. From there Medicare sends what is known as a “Medicare slip” which goes to the insurance carrier. From there it shows what Medicare paid (or didn’t pay), and the supplement pays the balance- no ifs, ands, buts about it.