MEDICARE SUPPLEMENTS
“Medigaps” are Medicare Supplemental policies or plans that offer standardized benefits to work with Original Medicare (not Medicare Advantage; more on those specific plans below). They are sold by private insurance companies. If you have a Medigap plan, it pays part or all of certain remaining costs after Original Medicare pays first. Medigaps may also cover health care costs that Medicare does not cover at all, such as care you receive when traveling overseas. If you have a Medigap policy, these only work with Original Medicare.
Plan Types
The number of private Medigap plans sometimes resembles a confusing “alphabet soup” of coverages. These plans are known by their lettered names, including: A, B, C, D, E, F, G, K, L, M, and N. Four other plans (E, H, I, and J) were dropped from Medicare in 2010, but some people who purchased these plans prior to that date may still have them, as they were “grand-fathered” in.
Each lettered plan pays for a certain set of benefits, which are the same regardless of which carrier sells the plans. Below are some highlights of each plan which you should consider before choosing a Medigap plan:
Plan A offers the most basic coverage for a core set of coverage gaps
Plan F is the most comprehensive, and covers the widest range of Medigap benefits. (Plans C and G are also very comprehensive)
Plans K and L only cover part of your Part B co-insurance costs, but both will pay 100% of your co-insurance AFTER you reach an out-of-pocket maximum.
Medigap plans are guaranteed renewable, so as long as you pay the premium, you can keep that plan you’re on. Keep in mind, however, that premiums may change annually.
Shop around and compare, because different insurance companies may charge different premiums for the exact same plan.
Exclusions
Medigap plans generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
If you decide to drop the entire Medigap policy (not just the drug coverage), you need to be careful about the timing. For example, you may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.
If you drop your entire Medigap policy and the drug coverage wasn't creditable or you go more than 63 days before your new Medicare coverage begins, you have to pay a late enrollment penalty for your Medicare Prescription Drug Plan, if you choose to join one.
MEDICARE ADVANTAGE
A Medicare Advantage plan is a type of Medicare health plan offered by private companies that contract with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage plans offer prescription drug coverage.
How Medicare Advantage Plans Work If you join a Medicare Advantage plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
Medicare health plans provide Part A and Part B benefits to people with Medicare who enroll in these plans, which include Medicare Advantage plans, Medicare Cost plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).
Medicare Advantage Plans Follow Medicare’s Rules Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
However, each Medicare Advantage plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year, so be careful on possible modifications.
Medicare Advantage Drug Coverage You usually receive prescription drug coverage through the plan. In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan.
You cannot have prescription drug coverage through both a Medicare Advantage plan and a Medicare Prescription Drug Plan. If you're in a Medicare Advantage plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be dis-enrolled from your Medicare Advantage plan and returned to Original Medicare.
Compiled by:
Gary Floring, We Speak Medicare
Serving Clallam & Jefferson Counties
360-434-6791