10 Things to Acknowledge When Considering Supplemental Medicare Plans

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photo courtesy www.kiplinger.com

Sometimes Original Medicare won’t get the job done. So we provided these 10 factors to help you choose additional private insurance coverage and get the care you so desperately need.

  1. Medical Conditions: Medicare Advantage Special Needs Plans can be a good choice for people with certain medical conditions, institutionalized individuals or Medicare-Medicaid dual-eligibles.
  2. Disability: Under 65 and on Medicare due to disability? You may not be guaranteed access to a Medigap plan. If you don’t have end-stage renal disease, you can get an Advantage plan if you’re Medicare-eligible- even if you’re under 65. *Medigap- pays for all or part of deductibles and coinsurance under Original Medicare (and a Medicare Part D plan will provide prescription drug coverage).
  3. Missed Enrollment: If you apply for Medigap outside of open enrollment you’ll face medical underwriting to determine your premium and eligibility. Medicare Advantage offers an annual open enrollment period.
  4. Extra Benefits: You may find extra benefits like dental, vision, hearing aids, and gym memberships in Medicare Advantage plans, but not in Medigap. Most Advantage plans also offer prescription coverage. If you opt for Original Medicare plus Medigap, you’ll need to buy a Part D plan to have prescription coverage. *Medicare Advantage- wraps everything all in one policy (Original Medicare benefits, cap on out-of-pocket costs + prescription coverage in most cases).
  5. Premiums: In most areas, there are “zero-premium” Medicare Advantage plans available. Medicare Advantage enrollees pay an average of about $158 a month, (including Part B premium). An Original Medicare enrollee with Medigap and Part D coverage would pan an average of about $320 a month (including Medicare Part B premium). *Plans vary from one plan to another. These are averages. *According to the Kaiser Family Foundation, 78% of Medicare beneficiaries have access to at least one zero-premium Medicare Advantage plan in 2015.
  6. Out–of-pocket exposure: With most Advantage plans, you pay coinsurance and copays, with out-of-pocket maximums up to $6,700 in 2015. Some Medigap plans pay first-dollar coverage for covered services, leaving you with little to no out-of-pocket exposure.
  7. Travel plans: Original Medicare doesn’t typically cover foreign travel. Six of 10 Medigap plans provide some coverage for foreign travel.
  8. Network size: 96% of doctors who provide Medicare-covered services are participating providers with Original Medicare, and coverage is nationwide. Each Medicare Advantage plan has its own network, and providers may be limited to a local or regional area. *Original Medicare paired with a Medigap plan plus Part D coverage might be the better choice if network size is a concern.
  9. Plan availability: Most Medicare beneficiaries have access to a wide range of Advantage, Medigap, and Part D plans, but options vary considerably by location.
  10. Plan change flexibility: Medicare Advantage and Part D plans have an annual open enrollment period that lets enrollees switch plans. In most states, Medigap issuers can use underwriting to determine your eligibility and premiums outside of your initial enrollment period. *If easily switching between plans is important to you, a Medicare Advantage plan will give you that flexibility.

 Sources: Medicareresources.org, healthinsurance.org, medicare.gov

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