We can help with Supplements and Advantage Plans…
There are generally two choices for those on Medicare, Supplements and Advantage Plans. 95% of all people currently on Medicare, or going on Medicare for the first time don’t understand the vast differences, or realize the choice one makes could possibly affect you, literally, for the rest of your life and result in the overpayment in premiums and out of pocket expenses. Side by Side comparison of Supplements and Advantage Plans
Advantage Plans
Learn about HMO, PPO, PFFS, SNP and HMOPOS plans
Medicare Advantage Plans
You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.
If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. This is different than a Medicare Supplement Insurance (Medigap) policy.
There are the different types of Medicare Advantage Plans:
- Health Maintenance Organization (HMO) plans—In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.
- Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you
use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network. - Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
- Special Needs Plans (SNPs)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.
- HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow you to get some services out-of-network for a higher copayment or c
Who can join a Medicare Advantage Plan?
You must have Medicare Parts A and B and live in the plan’s service area to be eligible to join. People with End-Stage Renal Disease (permanent kidney failure) generally can’t join a Medicare Advantage Plan.
How much do Medicare Advantage Plans cost?
In addition to your Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join.
What do Medicare Advantage Plans cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.
Most Medicare Advantage Plans include Medicare prescription drug coverage
(Part D). In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage.
Plan benefits can change from year to year. Make sure you understand how a plan works before you join.
Supplements or Medigap Plans
Supplements are an important part of Health Insurance. Let us help you learn more.
Medicare Supplements ( aka Medigap Policies)
Original Medicare pays for many, but not all, health care services and supplies.
A Medigap policy is private insurance that helps supplement Original Medicare.
This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage. If you have Original Medicare and a Medigap policy, Medicare will pay
its share of the Medicare-approved amounts for covered health care costs. Then
your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits.
All Medigap policies must follow Federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. All plans offer the same basic benefits but some offer additional benefits. You can choose which plan meets your needs.
Medicare doesn’t pay any of your costs for a Medigap policy.
Generally, you must have Medicare Parts A and B to be able to buy a Medigap policy. The best time to buy a Medigap policy is on the first day of the month in which you’re 65 or older and enrolled in Part B. This time period, called your Medigap Open Enrollment Period, ends 6 months later. During this period, an insurance company can’t refuse to sell you a policy or charge you more because of your health. If you’re under 65, you won’t have this Open Enrollment Period until you turn 65, but state law might give you a right to buy a policy before then. Note: A Medigap policy covers only one person. Spouses must each have their own policy.
How much do Medigap policies cost?
You pay a monthly premium to the private health insurance company that sells
you the policy. The premiums will be different for plans with different benefits
(for example, Plan A compared to a Plan F), but will also differ among insurance companies selling the same plan. Therefore, it’s very important to compare policies and their costs. Note: If you buy Plan K, L, or N, you’ll pay part of the Part B coinsurance and copayments, which may result in lower premiums for some Medigap Plans. Also, plans called “Medicare SELECT” may cost less because they’ll only provide benefits if you use specific hospitals or doctors.
Where can Medigap policies be used?
Unless the policy is a “Medicare SELECT” policy, a Medigap policy can be used in any U.S. state or territory, so you don’t need to buy a new one if you move.
Do Medigap policies cover prescription drugs?
New Medigap policies don’t offer prescription drug coverage. If you want prescription drug coverage, you must get a stand-alone Medicare Prescription Drug Plan that works with Original Medicare, or you can leave Original Medicare and join a Medicare Advantage Plan that offers drug coverage.
How do Medigap claims work?
You get a Medicare Summary Notice (MSN) every 3 months from Medicare that lists your health insurance claims information. It’ll tell you if Medicare paid the claim and if it’s been sent to your Medigap insurance company. You should compare your MSN to any statement you get from the Medigap insurance company and any bill you get from a provider.
Can my Medigap policy be cancelled?
Any Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
Compare Pennsylvania Medicare Plans
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. |
We can help with Prescription Plans…
Would you like some help paying for prescription drugs?
See the eligibility guidelines below for PACE/PACENET to see if you qualify. Don’t qualify for PACE or PACENET?
- If you qualify for PACE/PACENET, contact our Specialists to schedule an appointment to start saving as soon as possible. We can be reached at (724) 603-3403.
- If we can’t qualify you for PACE/PACENET, our Specialists can advise you on other ways to save you money on your premium and prescriptions!
Contact us for an appointment today!
Call (724) 603-3403
Why choose The Health Insurance Store for your Medicare needs?
Consultations in our office, over the phone, or in your home are always free of charge.
Our licensed agents are brokers, appointed to sell plans from virtually every company in the market, assuring you get unbiased advice.
Customer service second to none. We have a staff dedicated to helping you with billing questions, prescription issues, denied claims, etc. You will never have to spend time on the phone with insurance companies or billing departments. We take care of that for you with a simple phone call or visit to the office.
We help determine if you qualify for cost saving programs like PACE, PACENET, Extra Help on Prescriptions through Social Security, Part B Assistance, etc., and help you apply.
We review your policy/policies annually, ensuring you always have the best value in coverage year after year.
Erie County Area
1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276
Fayette/Westmoreland County Area
121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402
Pittsburgh Area
21 Yost Blvd., Forest Hills, PA 15221
Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
Fax: 878-302-3149
Albuquerque/Santa Fe, New Mexico Area
821 Coors Blvd. NW
Albuquerque, NM 87121
Phone: 505-200-0069
Fax: 505-200-0073