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Medicare Basics

Oct 23, 2019

Before choosing a plan we want to be sure you know the difference between your many options; In particular how Medicare Supplements and Medicare Advantage Plans differ. Many people sign up for Advantage Plans thinking they are Supplements, they are not.

Medicare Supplements

A Medicare Supplement is used with original Medicare. Any caregiver that accepts Medicare will take a Supplement because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare-covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%).

It is important to note that Supplements do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP. (there are exceptions to this) A Medicare Supplement does not change year to year (although the cost does generally go up the coverage does not change).

Medicare Advantage

A Medicare Advantage plan works differently than a Supplement. With a Medicare Advantage Plan, a private company TAKES OVER for Medicare (you remain in the Medicare system but Medicare is no longer responsible for your bills). These plans follow the same type of module as many group plans such as HMO or PPO. With this type of plan, it is important to remember several things.

    First, most Advantage Plans have Networks so you want to make sure your Doctor, Hospital, and auxiliary care are within the network. (otherwise, you will be paying higher costs and in some cases are responsible for 100% of care outside the network)
    Second, Advantage Plans have co-pays associated with them. It is important to be aware of these because they can add up to be quite a bit of money. Third, most Advantage Plans have the Part D “built-in” which is a nice bonus but you must be aware that when switching to a Supplement from an Advantage Plan you will also need to add a Part D. (there are several types of Advantage Plans that do NOT have the Part D built-in so this is something you need to keep in mind when choosing any plan).
    Lastly, Advantage Plans typically have value-added benefits. These benefits vary between plans but typical benefits include Health Club membership, limited dental, eye and/or vision.

Also, not all Plan D’s are the same. Although they are required to be at least as good as the Medicare model they can vary greatly in costs, co-pays and specific drugs that are covered. It is important to check which one suits you and continue to check each year because they (like Advantage Plans) do change every year.

Because these plans vary even from county to county, we strongly recommend that you talk to an independent insurance agent to help you choose the one that best suits your needs.

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