By Christian Regalado
Whether you are just aging into Medicare, or have been receiving this benefit for years, deciding if Medicare Advantage or a Supplement plan is best for your needs may come up many times. However, one thing is abundantly clear. It is very important to choose one of them. I’ve spoken with many seniors who didn’t understand the importance of choosing a plan. It can not only save many thousands on medical costs but also allows you to afford you to the best care possible. This is why I write these articles. It is my job to help as many people as possible learn all about their options for coverage.
Generally, the immediate importance of choosing a plan is to ensure maximum out-of-pocket costs for any possible medical issues you may experience. The co-insurance on Medicare A and B can add up to many thousands or even tens of thousands of dollars without a Supplement Plan or Advantage Plan attached. Many Medicare Advantage plans do not have a premium. So there is no extra cost to enroll, you just need to know to enroll. There are also many extra perks with Advantage plans including dental coverage, vision, free gym memberships, Prescription Drug Plans and more. Supplement plans are the most comprehensive medical coverage with a higher premium but very low out-of-pocket costs for medical care. However, Supplement plans do not include prescription drug or dental coverage like most Advantage plans cover.
If choosing a Supplement plan, it is important to remember to choose a Prescription Drug Plan (PDP) during the Initial Enrollment Period. There is a penalty added to PDP premiums, which increases every month a recipient delays purchasing the plan. PDP plans can run from $0 to about $100 depending on the drugs the plan covers. If you miss enrollment during your Initial Enrollment Period, you will need to wait until Annual Election Period before enrolling in a new plan unless you qualify for a Special Enrollment Period.
What did I learn this last Annual Enrollment Period? It seems that advertising works, especially the constant ads that feature “free stuff.” I had a few clients that were on Original Medicare with a great Supplement plan, and I received notice that they canceled their Supplement plans. Medicare laws prohibit me from calling, so I can only guess why.
My guess is some of them saw one of the thousands of ads promoting Medicare Advantage plans and called the 800 number. A well-trained sales agent then told them they could save money by switching off their Supplement plan and on to an Advantage plan. Premium-wise, that’s true.
They will save money, but they won’t have the same level of protection they had with their Supplement plan.
A significant difference between Supplement and Advantage plans is one’s healthcare “gatekeeper”. If you’re on a Supplement plan, it’s your physician who decides the treatment you receive, not your insurance carrier. If a procedure or treatment is covered by Medicare, additional approval is not required. On a Medicare Advantage plan, the insurance company requires prior approval, and your plan can deny treatment recommended by your doctor.
On a Plan G, after the $240 Part B deductible is paid in 2024, everything insured by Medicare is covered at 100% for the rest of the calendar year.
Advantage Plans often have Out of Pocket Maximums of $3,500 – $5,000, and as high as $8,000.
Advantage plans are affordable plans that work well for most people; When people choose a Supplement plan, it’s often because they want the strongest medical coverage available, and that’s what Medicare Supplement plans offer. Which plan is best for you? That depends on your anticipated medical expenses and your budget. If you are thinking of changing coverage, give us a call to discuss what your options are and when you can make any changes.
If you’ll be turning 65 soon or will qualify for new coverage for any reason, we can help. We work with many insurance carriers and are always happy to help educate you on your best options. Give us a call! Reach Christian Regalado at (850) 687-7606 or email christian@evergreenhealthins.com.
Author: Sowal Editor
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