Medicare Advantage and Supplement Plans, Understanding the Difference

Two main options exist when it comes to covering expenses not taken care of by straight Medicare. Medicare advantage plans and medicare medigap plans. Because there is a lot of confusion between the two I would like to address the main differences. Typically there are always exceptions to any rule so please check with your qualified representative to insure your best option.

Medicare advantage plans usually have premiums that are lower that medicare supplement plans. Additionally, prescription drug coverage is usually included in the plan. A medicare advantage plan is typically set up as an HMO which means you have to choose your primary care physician. If you need to go to a specialist a referral would be required. When care is provided on this type of plan there is usually a copay that needs to accompany the visit. Plans changes can only be done on these plans during open enrollment periods.

There are some medicare advantage plans that do provide a greater degree of flexibility in choosing doctors. Those types of plans would be considered PFFS or PPO plans. Both of these plans usually require a monthly premium.

Medicare supplement options work differently than medicare advantage plans. On a medicare supplement plan Medicare is your primary insurer and the medigap plan is what is called your secondary insurance. There are several types of medicare supplement plans. For explanation purposes I will concentrate on plan F.

On a medicare supplement plan you are not limited to having to have a primary care physician. You can go to any doctor (primary or specialist) that accepts medicare. This includes out of state coverage.

If medicare is your primary insurance you will need a part D (prescription drug plan) that will have to be purchased separately. The average cost of a plan D is $30.00 per month.

Changes on a medicare supplement plan may be made at anytime. However the company that you are switching to may require underwriting.

A medicare supplement plan F would take care of doctors office visits so no copay would be necessary. Additionally, there would be no hospital copay or deductible.

Because of the enhanced benefits there is a monthly premium required for medigap plans.

By providing details on the different available options my hope is that you can make an informed decision.

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How Do You Find the Best Medicare Supplement Insurance Plan?

As of January 1st 2006, 12 different medicare supplement insurance plans were made available to individuals that qualified for this type of coverage. The plans were all given alphabetical classifications. The classification scale ranges from plan A all the way to plan L.

Each of these plans offer different benefits in opposition to their other plans. Plan A, for example is the most inexpensive medical plan for an individual to obtain. While, on the other hand, Plan J offers the most benefits for people but is also the most expensive of the health care plans.

Be aware, that even though there were twelve different plans that were introduced to the health care industry, not every state offers all of these options to seniors seeking health coverage. Massachusetts, Wisconsin and Minnesota have their own plans, however the benefits are generally the same as the twelve advantage plans offered to seniors throughout the remaining 47 states.

The best time to purchase one of these insurance plans is six months after you have been enrolled into a Medicare Part B arrangement. During this time period, insurers are basically forced to accept you as a client, regardless of any pre-existing health care problems that you may have had.

In regards to the amount of funds that you may be asked to render for one of these policies, there are three things you need to be aware of. You need to remember that paying a higher premium for your coverage, does not constitute that it is better for you. Whichever company that you decide to go with, will pretty much end up giving you the same benefits. However, the key thing is finding a company that can attend to your budget needs as well.

Also, just like everything else in this world, Medicare premiums will increase overtime in order to keep up with inflation. You also need to have a keen knowledge regarding the three different methods that these agencies use to set their premiums.

Companies will review over the attained age of an individual, their issue age as well as where the person resides. Typically, the attained age for an individual to be able to receive Medicare is 65. As the person begins to age, their premiums will begin to increase as well.

All premiums are based on your age when you receive coverage. Basically, the older that you are the more money you will be asked to render for a particular policy. Also, people that live around each other will be asked to submit the same amount of money for their coverage. If a company decides to take advantage of community-rated policies, everyone regardless of their age will be able to receive coverage.

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Medicare Supplement Plans That Make Sense

Most of us would not be able to afford medical coverage if it weren't for the Medicare program. There are many different advantages to using Medicare, and more than likely you are already enrolled in Medicare part A and part B, which covers your hospital stays and doctors visits along with general medical coverage. There may be some gaps in coverage, however, and these generally show up in the form of annual deductibles and co-pays. If you would like to have additional Medicare supplement insurance which will cover these gaps, it is available in a type of insurance that is known as Medigap.

Medigap is a Medicare supplementary policy that helps to pick up any out-of-pocket expenses when you are using Medicare. It is important for you to look at these various policies that are available and to do a comparison in order to choose the one that is going to be right for you. The reason why this is the case, is because there may be some things that are covered under some of these policies that are going to be unnecessary for you. The best way to keep your premiums as low as possible is to compare Medicare supplement insurance in this way and you choose one that will result in the lowest premium and the lowest out-of-pocket expenses in the balance.

This can be a little bit difficult, but the Medigap insurance makes it a little bit easier because it is regulated. Regardless of which insurance company you happen to go with, the policies are going to be standardized and you will get the same exact coverage. For example, if you went with one insurance company and chose Medigap plan C, you're guaranteed to get the same exact coverage with any other insurance agency when choosing Medigap plan C.

One thing that is not regulated in Medigap insurance is going to be the amount of money that you're going to spend. As a matter of fact, there is going to be quite a variation in the cost of these policies, even when you are choosing the same one. That is why it can benefit you to do a little bit of comparison shopping, either by calling the various companies or by doing so on the Internet. In that way, you'll be certain to be getting the coverage that you need without paying too much for the policy.

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Medicaid and Medicare Beneficiaries Advantage Plan Options

If you are enrolled in both Medicaid and Medicare, you are considered to be a dual eligible individual. Your health benefits are coordinated between Medicare and your State's Medicaid program. It is important to know that, as a dual eligible individual, you have some choice when deciding on a Medicare Plan.

There are Special Needs Medicare Plans available for certain categories of individuals, including those that have both Medicaid and Medicare. A special Needs Medicare Plan is a type of Medicare Advantage Plan that is offered by a private insurance company. Insurance companies that offer Medicare Advantage Plans contract with and are approved by CMS (Centers for Medicare and Medicaid Services) to administer your Medicare Plan.

There are three types of Special Needs Plans (SNP)

Dual eligible Special Needs Plans for those with both Medicaid and MedicareChronic Illness Special Needs Plans for those with qualifying chronic illnesses.Institutional Special Needs Plans for those confined to a nursing home.

Part D Medicare Drug Plans are included in all Special Needs Plans. If you are dual eligible and have both Medicaid and Medicare, your co-payments will be subsidized and the Medicare Drug Plans generally will not require a monthly premium. In general, if you are enrolled in both Medicaid and Medicare, you will not pay a premium for your Special Needs Medicare Advantage Plan.

But if you have both Medicaid and Medicare, and Medicaid only allows for partial benefits, you may want to discuss your Medicaid status with your insurance agent to make sure a special Needs Plan is right for you.

The benefits of choosing a Dual Eligible Special Needs Plan

If you have both Medicaid and Medicare, a SNP may allow you more benefits than what you would otherwise have. Many include dental, vision, gym memberships, as well as transportation benefits to and from medical appointments.SNPs for those with both Medicaid and Medicare are generally network-based plans and may afford you some provider options that you otherwise may not have available.If you qualify, you are not subject to the enrollment periods that limit most people who would like to enroll in or change Medicare Plans.Part D drug plans are included in the SNP and you will only have to interact with one customer service department, should it be required.

Medicare Advantage Plans generally offer benefits beyond what original Medicare offers. As a dual eligible individual, you have the right to explore your options. Enrolling in a Special Needs Plan for people with both Medicaid and Medicare may give you more freedom of choice and some benefits you would otherwise not have available.

David Forbes is President of Alliance Marketing Associates, Inc. David offers helpful advice on topics related to insurance for seniors, including finding an affordable Medicare Plan.

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Medicare Supplement Insurance in California

Californians can purchase Medicare supplement insurance from several providers either direct or through an independent agent. Prices are controlled by law, so the monthly premiums will be that same no matter which avenue is chosen.

California allows Medicare supplement providers to offer insurance to those age 65 and above as well as those under age 65 and on Medicare disability. Not all states offer supplemental insurance to consumers under age 65 making CA unique in that regard.

Disability and

Those under age 65 will be afforded a 6 month open enrollment window just like those who age into Medicare. It is important for consumers on disability to explore all of their options during this period of time or they can later be turned down.

That is to say, if the open enrollment window of time has been missed, then medical underwriting may be necessary and those with a disability may not qualify for comprehensive coverage. Those who are accepted into disability, but covered under an employer sponsored plan can later apply for Medigap insurance when they separate from service.

California Medicare Anniversary or Birthday Rule

California is very unique in that it offers a yearly anniversary when Medicare beneficiaries can switch to like coverage. Very few states offer this benefit. The yearly anniversary is also referred to as the "birthday rule" and encompasses the month of the insureds birthday.

During this one month window, consumers can switch Medicare insurance plans so long as they are not upgrading to more comprehensive coverage. If an upgrade is desired, then medical underwriting will be necessary.

Like coverage simply means the same (or less) Medicare supplement insurance coverage. For example, consumers on Plan F can purchase a new Plan F from a competing insurance company in order to lower their monthly premiums. This might be done every couple of years when Medicare supplement premiums have had an above average premium increase.

In summary, residents of CA who are eligible for Medicare have several options available to them when shopping for a Medicare supplement insurance plan. It may be wise to work with an independent agent who can provide quotes from several competing companies. This can help keep monthly rates low at inception as well as in the future.

Consumers owning Medigap insurance above or below age 65 should explore all of their options during their birthday month. This yearly anniversary can be used to purchase like coverage at a lower price, thus maintaining lower premiums each year.

A.M. Hyers has been working in the insurance and investment industry for over 14 years. He owns and operates Hyers and Associates, Inc. an independent insurance agency doing business across the United States. They use several carriers to quote Medicare supplement plans and Medicare Part D coverage for seniors.

His agency offers insurance products in the individual, family, and small business group marketplace. They use the leading national insurance carriers to quote health insurance, health savings accounts, dental, and vision plans.

Other lines of insurance offered include life insurance, disability insurance, and long term care insurance. Additionally, the independent agents of Hyers and Associates Inc. offer fixed, indexed, and immediate annuity policies for individual and group retirement plans.

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