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Original Medicare offers great Medical Coverage. Even though Medicare comes with co-pays and co-insurance for which you are responsible, you can get such payments covered through a Medicare Supplement (Medigap) plan. In fact, the US Government has standardized such plans, so that you have an opportunity to get such costs covered for a reasonable premium, and get such Medicare copays and coinsurance covered.
When people talk about Medicare costs, you may hear the phrase “out-of-pocket” used frequently. But what does it mean? “Out-of-pocket” medical expenses regarding Medicare refers to any Medicare healthcare expenses you have to pay yourself. With Medicare, these expenses may include copayments, deductibles, and coinsurance amounts.
As a result, many people on original Medicare enroll in a Medicare Supplement (Medigap) plan to help with Medicare approved amounts for such out of pocket expenses. For instance, Medicare only pays for 80% of the Medicare approved amount for most doctor services, outpatient therapy and durable medical equipment, while you typically would have to pay 20%. A Medicare Supplement (Medigap) plan would cover your 20% charges.
A Medicare Supplement (Medigap) plan is different from a Medicare Advantage Plan.
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans” are an all in one alternative to Original Medicare. Medicare Advantage is a way to replace Original Medicare benefits, while a Medigap policy supplements Original Medicare benefits. Medigap (or Medicare Supplement) plans offer to fill the gaps in your basic Medicare coverage for Medicare approved Amounts.
When getting a Medicare Advantage plan, you are replacing your Original Medicare plan. These plans are offered by private insurance companies that are approved by Medicare. With Medicare Advantage, you will be limited to the doctors or hospitals that you can go to depending on what plan you have and your location. While such plans have to provide the same type of coverage under Medicare Part A and Medicare Part B, there still may be gaps in such coverage.
A licensed agent, specializing in Medicare, can assist you in comparing coverage, so that you can make the right choice for your health & lifestyle.
Before deciding on Medicare coverage, it is important to understand the difference between Original Medicare coupled with a Medicare Supplement (Medigap) Plan and a Medicare Advantage Plan.
Medicare Supplemental Plans (Medigap)
- You are on Original Medicare.
- A Medicare Supplement (Medigap) plan Supplements Original Medicare.
- New enrollees can choose from 9 different plans.
- A monthly premium, but no copays or co- insurance, because the plan covers such costs.
- Able to select your own doctors and hospitals.
- No referrals necessary for specialty doctor visits.
- Coverage applies anywhere in the U.S.
- Can apply for coverage anytime after turning 65 and joining Medicare Part B.
- Pay a monthly premium for the plan in addition to Part B premium.
- Prescription drug coverage is not included.
Medicare Advantage Plans
- Replaced Original Medicare.
- Plans are offered by private insurance companies that are approved by Medicare.
- Typically required to use in-network doctors and hospitals.
- May need referrals for specialist visits, and in-network providers must give care.
- Includes network restrictions.
- Emergency care covered for travel within the U.S.
- Only specific periods when you can enroll or switch plans.
- Pay a low or $0 monthly premium.
- Personally responsible for copays, coinsurance, and deductibles.
- Prescription drug coverage is usually included (MAPD).
One option is typically more expensive but includes more benefits, while the other is less expensive but has more restrictions. The Benefit Link represents and or has access to virtually every major insurance carrier and their plans. The company continually monitors the overall senior market insurance industry by tracking premiums, rate increase history, and trends. Contact an expert today to find the right Medicare option for you!