Medigap plans, also known as Medicare Supplements, provide coverage for the Deductibles and Copays that Original Medicare does not cover.
Medigap plans do not cover Prescription drugs.
Medicare Advantage plans, also known as Medicare Part C, cover Hospitals, Doctors, and Prescription Drugs as well as other benefits.
Which plan is better for you?
It depends.
What do Medicare Supplements or Medigap plans cover?
Original Medicare has two parts to it: Part A and Part B.
Part A covers Inpatient care in Hospitals and Skilled Nursing Facilities, Hospice care, and Home health care.
For most Americans, who have worked regularly throughout their life, Part A has no premium.
Part B covers Doctor’s services, Outpatient care, Home health services, Durable Medical equipment, Mental Health and Preventive services.
Part B will have a monthly premium in 2022 of $170.50. Many people pay this premium by having it deducted from their Social Security benefit each month.
Part A has a Deductible estimated to be $1556 in 2022 and this needs to be paid each time you use the benefits.
So 2 hospitalizations equals 2 deductibles.
Part B has a Deductible estimated to be $217 in 2022.
In addition to these deductibles, there are numerous Copays in both Part A and Part B.
Medigap policies try to fill in these deductible and Copay gaps, so the beneficiary has little or no out of pocket costs except for the premium.
What do Medicare Supplement policies not cover?
They won’t cover items that are not Medically necessary and they won’t cover Doctors or Hospitals that do not accept Medicare.
But the main issue for most people is that Medicare Supplements do not cover Prescription Drugs.
That is where Medicare Part D come into play.
Medicare Part D plans cover Prescription Drugs and supplement the Medigap plans to provide this coverage that most seniors need.
Remember you will have to pay extra for Medicare Part D in addition to what you will need to pay for the Medicare Supplement.
What do Medicare Supplement or Medigap policies cost?
Medicare Supplement plans are standardized and are named Plan A through Plan N – depending on the coverage offered.
There is a wide range of premiums and the cost will vary depending on how old you and where you live.
In South Florida your premium could range between $125 a month to well over $300 a month if you are 65 and higher if you are older.
Add to that the $158.80 for the Medicare Part B premium.
Plus your premium for Part D and you could be paying $500 a month for Medicare, the Supplement and Part D Prescription Drug coverage.
What do Medicare Advantage Plans Cover?
Medicare Advantage plans, also known as Medicare Part C, are offered by Medicare-approved private companies (like Florida Blue).
These companies must follow all the rules set by Medicare.
Medicare Advantage plans cover all of your Part A and Part B benefits.
These plans cover all emergency and urgent care, and almost all medically necessary services that Original Medicare covers.
Most importantly, Medicare Advantage plans also cover Prescription Drugs.
Medicare Advantage also offer extra benefits, like dental, vision, hearing, home health care, and Gym memberships.
What kind of Medicare Advantage plans are there?
- Health Maintenance Organizations (HMO) for low copays in exchange for staying in the Network.
- HOM Point of Service plans (HMOPOS) which give some limited out of Network coverage.
- Medical Savings Accounts
- Preferred Provider Organizations (PPO) provide in and out of Network coverage.
- Private Fee-for-Service plans (PFFS)
- Special Needs Plan (SNP)for people with Medical conditions that require special care.
What Do Medicare Advantage plans cost?
With Medicare Advantage plans you still have to pay your $158.80 for Part B.
The average Part C plan nationwide costs about $25 a month.
Florida Blue offers both HMO and PPO plans for $0 premium each month.
These plans have large networks of Doctors and Hospitals and Florida Blue has worked with Medicare for more than 50 years.
So what Kind of plan is better For YOU?
Here’s some scenarios to keep in mind when choosing between Medigap and Medicare Advantage;
If your Prescription costs have gone up or not being covered: try getting a different Part D plan or Medicare Advantage.
If you decide to spend summer in a different state: try Original Medicare with a Supplement or Florida Blue Medicare Advantage PPO.
You’re super healthy and rarely go the doctor: try Original Medicare or Medicare Advantage with extra benefits like Silver Sneakers gym membership.
If your income has dropped drastically: Try Florida Blue’s Advantage HMO Saver plan for a $75 rebate on your Part B premium.
You do not want any limitations at all on which doctors or hospitals: try Original Medicare with a Medigap policy.
You’ve been diagnosed with a chronic condition: try Original Medicare with Part D and a Supplement or Medicare Advantage with a large network of specialists and good Drug coverage.
So if you want no restrictions on Doctors and Hospitals and the monthly premium is not a problem for you, original Medicare with a Medigap and Part D Prescription plan might be the way to go.
If you can work with the Network of Doctors and Hospitals, and want a low premium, Prescription drug coverage and extra benefits then the Medicare Advantage plans should be a good fit.
Either way, you should consider the only company that has offered Medicare plans from the beginning, has never left Florida, and has a large network of Doctors and Hospitals that can’t be beat by any other company.
Florida Blue.
And you can get Florida Blue by contacting Cronin Insurance.
Cronin Insurance is the Wise Choice.
