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Medicare Supplement/Medigap

  • Medicare Supplement/Medigap plans are an addition to Original Medicare

  • Supplement plans are offered by private companies

  • The Supplement pays your 20% portion of medical costs

  • There is a monthly premium that you pay for coverage.  When you pay your premium, you typically don't pay when you go to doctors of hospitals

  • Your premium costs are subject to rate increases

  • Plans are designed for people over 65.  You can get a plan if you are under 65 but the cost is higher

  • You have a guaranteed time to get into a Supplement plan, which is when you turn 65.  If you choose to get a Supplement plan without a guarantee issued time, you will be subject to under-writing to qualify

  • You can go to any doctor in the US that accepts Medicare

  • No pre-authorizations necessary

  • The plans are standardized, meaning that plans are required to offer the same coverage.  You may get different rates based off of you age and location but a Plan G covers the same way, regardless of what company you go through

  • These plans are excellent options if you travel

  • If you choose a Supplement, you'll need to add a separate Part D plan for drugs

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Medicare Advantage

  • The insurance companies pays your bills instead of Medicare and you follow the rules of the plan, instead of Medicare.  These plans look like group health plans that you may have gotten previously through an employer

  • You will typically see co-pays, set amounts you pay for each service

  • Medicare Advantage combines Part A, Part B and Prescription drug coverage into one plan

  • You can get additional benefits not covered by Medicare such as dental, vision, hearing, gym memberships, and over the counter products

  • These plans are the only type of plans you can have if you have Medicaid

  • You have networks of doctors, you have to use in-network doctors or you pay higher costs.  You also have referrals on some plans

  • You can get these benefits at a $0 premium

  • You can get a co-pay of $0 for your primary care doctor co-pay

  • There are maximum out-of-pocket costs with Medicare Advantage plans

  • You typically keep your plan for the entire year.  You are eligible to change plans at the end of every year if you choose

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        Medicare Supplement Benefits Chart

                                                                                   Plan    Plan    Plan    Plan    Plan    Plan    Plan    Plan    Plan    Plan                                                                                                    A         B         C         D         F        G         K         L         M        N

 

Part B (Medical) Copay/Coinsurance                         100%  100%   100%    100%   100%  100%  100%   100% 100%  100%

Blood (first 3 pints)                                                   100%  100%   100%    100%   100%  100%   50%    75%  100%   100%

Part A Inpatient/Hospice                                           100%  100%   100%    100%   100%  100%   50%    75%  100%   100%

Skilled Nursing                                                            X         X       100%    100%   100%  100%   50%    75%  100%   100%

Medicare Part A Deductible                                        X       100%   100%    100%   100%  100%   50%    75%     X       100%

Medicare Part B Deductible                                        X         X       100%       X       100%    X        X         X        X         X

Foreign Travel Emergency                                           X         X       80%      80%    80%    80%     X         X       80%    80%

  

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