If you’re soon turning 65, one of the biggest decisions you’ll be asked to make is between a Medigap Plan (Medicare Supplement Plan) or Medicare Advantage. How do you choose what’s right for you?
Differences
Medigap works with Original Medicare. Medicare Part A & B will cover almost all of your medical needs such as:
- Doctors Visits
- Mental Health
- Hospital Procedures
- Medical Equipment
- Ambulance Services
- Skilled Nursing Care
- And More
However, there are costs for these services. There are deductibles to meet as well as copays and coinsurance.
Medigap
Medigap plans will help to cover these additional costs. You will have to pay an extra premium though. So if you can comfortably afford an extra monthly premium in order for peace of mind, then you may want to consider a supplement plan.
Medigap plans will enable you to see anyone who accepts Medicare as well as utilize any hospital that accepts Medicare. That is, to say, almost all of them. So, if you need or want access without network restrictions, Medigap is the way to go.
Medicare Supplements may also give you more flexibility. Usually there are no referrals needed to see specialists. You also won’t need a PCP.
Medicare Advantage
Medicare Advantage is an alternative to Original Medicare. It must offer at least the same benefits as original medicare, but you’ll be beholden to a network. Very often it offers additional benefits such as dental, vision, prescription, hearing and more.
Oftentimes you can opt to enroll in a Medicare Advantage plan and just continue to pay for Medicare Part B. Some plans will even offer you a rebate towards your Part B premium.
Many opt for a Medicare Advantage plan because of these additional benefits and cost savings. However remember, there are definite downsides. The networks can be very restrictive and it can be difficult to find doctors and hospitals who accept your plan.
Additionally, although there are OOP maximums, if you need long term medical treatment, perhaps for something like cancer, when your OOP max resets, you will once again have to meet those large bills.
There are times, however, when you should consider a Part C plan. For example, if you are eligible for a special needs plan such as a DSNP or CSNP.
DSNP
DSNPs are dual eligibility special needs plans. They are a type of Medicare Advantage plans available to people who are eligible for both Medicare and Medicaid. These plans must offer all of the same benefits as Medicare plus the benefits of Medicaid in addition to many other benefits. They can be quite all encompassing and cost effective.
CSNP
A CSNP is a chronic condition special needs plan. If you have been diagnosed with one of a very long list of chronic conditions, you may be eligible for a CSNP. These types of Medicare Advantage plans are tailored for certain conditions. For example a CSNP for diabetics might have low cost insulin and a wide network of podiatrists with a low copay. A CSNP for heart disease might offer low cost pulmonology or cardiology.
Managed Care Plans may also be a great choice if you live in certain areas. Because these plans rely on networks and carriers, there are just some areas of the country where Medicare Advantage is more prevalent than others. For example, Medicare Advantage is more common in many areas of Florida.
If you are interested in Medicare Advantage, please consider working with a broker. And remember, if you decide to try a Part C plan and it turns out that it’s not right for you within the first yearn you are still in your trial right period and can make the switch back to Original Medicare with a Medigap Plan.
Call iHealthBrokers at 888-918-0518 or schedule an appointment today. Our services are 100% FREE!
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
