Medicare can be confusing. We can all agree on that. But it doesn’t have to be. What it really boils down to is that your options are limited, which makes things quite simple. You can go one of two routes. The first is an Advantage Plan and the second is a Supplement, or what some people may refer to as Medigap. Let us break these down to hopefully help you decide which is the best fit for you and your health care needs.
Keep in mind that this is after you’ve already enrolled in “original” Medicare Parts A and B, which provides the basic hospital and physician coverage. See our video here for instructions on enrolling in Parts A and B: How to enroll in Medicare parts A and B. That must be done first, and then you can essentially “buy up” whichever other coverage you’d like.
• Route 1: Medicare Advantage Plan
Think of this option as a replacement policy for A and B. It essentially takes the place of your original coverage and is used just like an individual under 65 health plan would be. Most times, there are copays or coinsurance for services, a deductible to meet and an out of pocket maximum. This plan will have out of pocket expenses but the monthly premium is typically very low, considering. With this plan, you would use this card at the doctor in place of the original Medicare ID card. Advantage Plans and their provider networks can vary by county so it’s always safe to confirm that your physicians are part of the network.
Example of coverage: The current Florida Blue Medicare Advantage Plan for 2020 has a monthly premium of $47.90. Pretty inexpensive, right? There is coverage such as a $10 copay for an in-network family physician, $45 copay for a specialist, $50 copay for urgent care, $90 copay for ER visit, $295/day for inpatient hospital care, and a $6,500 out of pocket maximum. This plan also has prescription drug coverage built in at different tiers depending on the medication.
Ideal client for this plan: Someone that may not visit the doctor often, has no major health concerns or current struggles, has the financial ability to pay the out of pocket maximum in the event something big happens unexpectedly.
• Route 2: Medicare Supplement (“Medigap”)
A supplement is in addition to original parts A and B. It fills in the blanks of what A and B don’t cover. Now because of that, it will only cover things that Medicare does because it basically follows suit with Medicare and then supplements the gaps afterwards. This plan does not have copays or coinsurance or out of pocket expenses. It has a higher monthly premium so that it covers almost everything at the time of service. At a Doctor visit, you would use your original Medicare ID card first along with this one.
Example of coverage: There are several different levels of supplements but the most popular one that is available now is the plan G. There is an annual deductible for the part B coverage that the supplement will have, which is $198. Once that is met, essentially everything is covered at 100%. The current plan G monthly premium in Gainesville, FL is $180.60. It’s important to note that the supplement does not cover prescription drugs and those must be purchased in a separate Part D plan. I know this sounds like alphabet soup but stay with us!
Ideal client for this plan: Someone that frequents the doctor, has some health issues or is prone to illness, can afford the higher monthly premium for peace of mind, or someone that just doesn’t want to have to worry about health care costs.
That’s it! Congrats! You made it through the treacherous trenches of Medicare. There are only two routes and you get to pick! We always like to get a better feel for clients’ individual situations and health care needs to better advise the best fit but it’s pretty simple. And as we mentioned, there’s a separate Part D drug plan for prescription coverage with the supplement route… you can get more information on that here: Part D drug coverage. If we can ever be of assistance and help simplify this process or guide you to a decision you’re comfortable with, please contact us at 352-371-7977 or firstname.lastname@example.org.