Supplements vs. Advantage plans, which is best for you?
Advantage Plans (Part C of Medicare)
Supplement Plans (Medigap)
|Cost– As little as $0 per month to almost $300/month.||Cost- Start around $85-100/month. Generally, will also need to be paired with a Part D Prescription Plan that run $14-18/month for the majority of people.|
|Coverage– All companies must offer the same 29 categories of medical benefits. The differences between plans and companies are monthly premiums, what your co-pays, co-insurance, and deductibles are in each of the 29 categories, and the most you could be billed in a calendar year, known as the Maximum Out of Pocket (varies between $3,400 and $6,700). The portion of Medical bills you are responsible for are detailed in the Summary of Benefits found in each company’s “Enrollment Kit.”||Coverage– Designed to pick up the remainder of the bill that Original Medicare parts A and B does not pay.|
|Benefits– 1) Low cost, as little as $0 per month. 2) No underwriting. Everyone is accepted unless they have End Stage Renal Disease. 3) Some plans have limited vision, hearing, and dental benefits, as well as no cost gym membership programs. 4) Most plans come with prescriptions in one all-inclusive premium.||Benefits– 1) Very easy to understand and highly Federally regulated. You pay your premiums and almost nothing else. There are no co-pays for doctor visits, surgical procedures, diagnostic tests, ambulance rides, hospitalizations, etc., with the exception of Plan N 2) You have the right to go to any doctor or facility in the country that accepts Medicare Assignment. No matter what company your supplement is with, the doctor or hospital must accept it if they accept you as a patient. There are no networks to worry about.3) Benefits rarely, if ever change. This means you will always have little or no out of pocket expense.|
|Negatives– 1) Plans are HMO’s or PPO’s. With HMO’s, you must get your care from participating network doctors, facilities, and hospitals. You are generally only covered out of the area in an emergency. With PPO’s, you do have the option of seeing out of network providers, however, if you choose to do so, you could be billed thousands of dollars more. 2) Premiums can rise. In the past, some plans have increased 50% or more from one year to the next. 3) Benefits can change year to year, often resulting in higher co-pays and out of pocket expenses. 4) Exposure to some potentially higher out of pocket costs, in the thousands of dollars, for some services like skilled nursing facilities, durable medical equipment, chemotherapy drugs, prosthetic devices, and hospitalizations. 5) Once enrolled in Advantage Plan, it may become impossible or unaffordable to enroll in a Supplement in the future.||
Negatives 1) Generally, more expensive than Advantage Plans. Premiums will increase as you age. 2) No vision, dental, hearing, or gym membership benefits. These will be paid entirely out of your pocket. 3) These plans can be medically underwritten in some circumstances. It is possible to be denied coverage outside of initial enrollment in Medicare Part B.
If you want to sign up for a Medicare / Medicaid Supplement or Medicare / Medicaid Advantage health insurance plan, feel free to call 724-603-3403 or email us a quote request!