06/30/2023
Time and again, I am asked, which is better - Medicare Supplement plans, or Medicare Advantage?
The correct answer - both and neither.
That may seem needlessly cryptic, and it is. Both plans serve different needs in the same market. It's like asking, which is better, flats or pumps? Depends on if you want comfort, or fashion.
Medicare Supplements, or "Medigap" plans, work ONLY with Original Medicare parts A & B. Medicare covers about 80% roughly of medical costs, and Part A (Hospital) has a $1600 deductible PER BENEFIT PERIOD (60 days). Original Medicare has no Maximum-Out-Of-Pocket, hence the need for a Medigap plan. The Medigap plans limit your out-of-pocket to as little as just the Part B deductible. However, the monthly premium is almost always over $130/month in addition to your Part B premium. And then you need to fund a Part D plan, which is a stand-alone Prescription Drug Plan, or PDP. That is an additional $7 to $107 per month, depending on your Rx list.
Medicare Advantage on the other hand, is very low or even no additional premium., and it includes Prescription Medications. Additionally, Medicare Advantage (MA) plans include extra benefits not covered by Medicare, such as Dental, Vision, and Hearing. All of your medical providers must come from a network of providers, and some MA plans are "HMO" plans, which means you need to see your P*P (Primary Care Physician) to obtain a referral before seeing any specialist. Other MA plans are "PPO", or Preferred Provider Organizations, which do not require referrals, and may have Out-Of-Network benefits.
There is something to be said for either method of coverage. And there are downsides to both, also. A good agent will tell you both the good AND the bad, so you can be better informed.
What usually happens though, is that an agent or agency will focus on either MA, or Medicare Supplements, but rarely both. This like a shoe store that sells only sneakers, or dress shoes, but not both. In the shoe business, that would be foolishness. Well, in the insurance business, this is also foolishness. Everyone's needs are different and unique.
Some folks have dentures. Do they need a high-priced dental plan? Of course not.
Some folks are veterans. They get a large portion of their health care and medications through the VA, Tri-Care, or ChampVA. Do they need to spend huge dollars on a Medigap plan? Absolutely not.
There are also Seniors who are "dual eligible"; that is, they have both Medicare and Medicaid through the State. There are MA plans that not only have zero premium, but the entire cost of Part B is covered, with $0 copays on all medical and hospitalization, as well as very low/no copays on prescription medications. These are called "Dual Special Needs Plans", or D-SNPs, and they can provide more benefits than either Medicare or Medicaid alone could do.
No doubt you've seen the commercials on TV about "stimulus" payments, food benefits, etc. These ads are highly misleading, and starting in 2023's Annual Enrollment Period, they will be disallowed by CMS. As I write this, various offenders are looking for loopholes around this. They wish to go on being misleading.
If you live in the area, and you are, or are going to be, new to Medicare, let us sit down over coffee and talk about your options. The alternative is to wait for one of these people on the phone to sell you what they wish to sell, not necessarily what you want or need. Our agency is about relationships, not about quick sales.
