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Medicare beneficiaries have the option to add on additional coverage
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that will supplement their original Medicare benefits.
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You can choose between a Medicare Advantage plan or a Medicare Supplement plan. Today
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we're going to compare both side by side
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so that you can make the best decision for your health care coverage.
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Hi, I'm Lindsey Engle and on the Medicare expert for Elite Insurance Partners and MedicareFAQ.com.
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When you enroll in Medicare, you have the option to enroll in Part A
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and Part B. Part A is your hospital coverage and Part B
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is your doctor's coverage or medical coverage.
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Now there are still many out-of-pocket costs when it comes to Part A and Part B.
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This includes a deductible and coinsurance. In order to fill in the gaps of coverage
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that original Medicare doesn't include you'll need to enroll in supplemental coverage.
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Now you have two options. You can either
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enroll in a Part D Plan with a Medigap plan
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or you can enroll in a Medicare Advantage plan. Option 1 includes
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enrolling in a Part D plan and a Medigap plan.
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Now original Medicare does not include prescription drug coverage.
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That's why you'll want to add on a standalone Part D plan.
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In addition, you'll want to enroll in a Medicare Supplement Plan also known
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as Medigap that will cover additional out-of-pocket costs that you're responsible to pay
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for. Medigap plans were specifically designed to fill in the gaps in coverage with original Medicare.
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This includes coinsurance
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and deductibles. Medicare Supplements literally supplement your original Medicare
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benefits. Medigap plans are attractive to many Medicare beneficiaries
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because they come with very little out-of-pocket cost in the form of cost sharing.
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All you have to worry about is paying your monthly premium,
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depending on the letter plan you choose you could have all of your
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cost-sharing completely covered a 100%.
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There are many benefits that come with Medicare Supplement plans. A few
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of them include, a large doctor network, benefits
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that travel with you nationwide
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and you don't need a referral to see a specialist The second option you
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have is to enroll in a Medicare Advantage plan.
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Now, it's important to remember that Medicare Advantage is not the same as original Medicare.
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These are managed health care plans that are offered through private insurance
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companies. Medicare Advantage plans do tend to have lower monthly premiums
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when compared to Medigap. In addition,
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some may come with ancillary benefits like dental
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and vision coverage. Some also include prescription drug coverage. Now
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due to the low or zero dollar monthly premium,
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you will have to pay more out-of-pocket as you use the benefits. Medicare Advantage plans
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also come with many limitations that original Medicare
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and a Medigap combined do not come with. This includes a limited network of doctors,
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the coverage will not travel with you and you need a referral to see a specialist.
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Now, you may be wondering how our Medicare Advantage plans free?
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Well we’ll explain. You see, the Medicare Advantage carrier is actually paid by Medicare around
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$1,000 a month to take on your risk. That is how they are able to offer such low premiums in some
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are zero dollar monthly premiums. In addition,
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they make money off cost-sharing. Unlike Medigap,
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you'll have co-pays to pay every time you see a doctor.
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So if you see multiple doctors with in one visit,
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let's say you go downstairs to get x-rays, upstairs
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too some blood work and across the hall to get an exam.
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Well, you very well could have three co-pays to pay for that one visit.
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It's also important to know that you still have to pay your
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monthly Part B premium. A common misconception with
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Medicare Advantage plans is that you don't have to pay the monthly Part B premium.
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This is not true. You are still responsible for the monthly Part B premium.
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You see many Medicare Advantage commercials throughout the year,
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especially during the annual enrollment period. This
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is because carriers want these policies to seem more attractive to you
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with their $0 premiums and additional extra benefits to make it this all-inclusive all-in-one plan.
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What you don't realize is they are getting paid by Medicare that take on your risk
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and they will make their money between Medicare
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and cost-sharing you pay out-of-pocket
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when you actually use those benefits. Now, Medicare Advantage
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plans do have to cover at least the same benefits
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as original Medicare.
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However, it is up to the carrier how much they will cover for that specific service.
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So while Medicare may pay 80%
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for your doctor visit, Medicare Advantage may cover less than that
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as well as throw on additional cost sharing in the form of co-pays and coinsurance.
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Now, when you combine all those up it can quickly add up to more
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than the monthly premium would have been
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for a Medigap plan.
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So is it better to have a Medicare Advantage plan or Medigap plan?
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Well, there is no one easy answer to this question.
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It really depends on your specific situation. One may not be better than the other.
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However one may be better than the other for you.
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Do you want to plan that comes with a free gym membership that you may
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or may not ever use or do you want a plan that comes with more comprehensive coverage in the
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case that you're diagnosed with a major medical condition.
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Now, we'll go over three things that you should consider
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when deciding between a Medicare Advantage plan and a Medicare Supplement plan.
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The first one is budget. Now, if you're unable to afford the monthly premiums
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for Medicare Plan enrolling in a Medicare Advantage plan is better than nothing.
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However, if you rather pay more money up front in the form of monthly premiums
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for a Medigap plan and have more predictable out-of-pocket cost
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as you use the benefits. Than a Medigap plan will be the better option for you.
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The second thing to consider is your medical usage.
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Do you visit the doctors often? Do you have multiple doctors? With Medicare Advantage,
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you're going to have a copay and possibly coinsurance.
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Every time you see a doctor. With Medigap,
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there is no co-pays and your coinsurance is covered
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and you won't have to worry if your doctor is included in the plans network
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since 96% of doctors nationwide accept Medicare.
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Again with Medicare Advantage you have a very limited network.
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So, if you happen to see two or three doctors,
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you may find that only one or two of them is actually in your plans network.
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The third thing to consider is if you travel often. With Medicare Advantage plans,
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they will not travel with you. Some are even restricted by County if you cross county lines,
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you may find that you're not going to have many doctors that are in the
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plans network. With Medicare supplement plans,
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your coverage will travel with you nationwide.
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The last thing I want to point out is that if choose to enroll in a Medicare Advantage plan,
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please consider that you may never be able to get enrolled in a Medigap plan if you want to
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do so later.
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This is because for most you only get a one-time Open Enrollment Period to enroll in a
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Medigap plan. This enrollment period will only last six months
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and it will begin the first of the month after your Part B effective
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date. During your open enrollment period you
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can enroll in a Medigap plan without having to answer any health questions
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and you're guaranteed to be accepted.
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And if you choose to enroll in a Medicare Advantage plan,
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but later want to switch to a Medigap plan and drop your advantage plan.
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You'll have to answer health questions and may not be accepted into the Medigap plan.
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If you need help deciding between a Medicare Advantage and a Medicare Supplement plan,
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give us a call. Our agents can compare them side-by-side
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and show you all the available options in your area.
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I hope you found this video helpful. Don't forget to subscribe to our
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YouTube channel. Make sure notifications are turned on
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so that you're notified each time
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We'll make sure to include a link below that you can join. Until next time.
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Bye.