Medicare explained | Compare Medicare Advantage vs. Medicare Supplements

Medicare explained Medicare is like a whole new language.  Just as you get use to terms like deductible, coinsurance, and copay during your working career, Medicare creates a whole new vernacular with terms such as Part A, Part B, Part C, Part D, PFFS, PPO, HMO, doughnut hole, etc. Our goal is to try and simplify Medicare so you can understand the basic options and what will fit you the best.

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When entering Medicare at age 65 or older, you have 2 basic options:

1) Keep Part A (Hospital Coverage) and Part B (Medical Coverage) as your primary insurance
     
 a) Buy a Medicare Supplement (Medigap) - The supplement will pay the balances left by Medicare such as
            Deductibles and coinsurance.  A good supplement like Plan F will pay for all covered charges not paid by
            Medicare.  Other Supplements may still leave you with deductibles or coinsurance to pay.
b) Buy a Stand-Alone Part D Prescription Plan - Supplements do not include prescriptions, so a separate Part
            D prescription plan must be purchased.  Part D plans are sold by private insurance companies such as
            Humana or Regence, with approval from Medicare.

2) Buy a Medicare Advantage Plan - Medicare Advantage Plans are sold by private insurance companies such as Blue Cross, Humana, or Regence BlueShield.  They are called All-In-One plans since they can include Part A (Hospital), Part B (Medical), and Part D (Drugs).  However, for those with VA benefits for example, most plans can be purchased without Part D for less premium.

Comparing Your Options - Medicare Advantage Vs. Medicare Supplements
  Medicare Advantage Plans Medicare Supplement Plans (Medigap)
Premium Least expensive option.  Many plans with Rx for less than $100.  Some for less than $50. More expensive option.  Supplement Plan F plus Rx plan often start at about $200 for most people
Out-of-Pocket Plans have copays for most services that can vary by plan but are usually relatively low A Supplement like Plan F will cover all your deductibles and often leave you with no out of pocket
Convenience Convenient because Part A, Part B, and Part D Rx is all in one plan, so you can deal with one company and one card.

Inconvenient for those that are in need of constant care and will be receiving frequent bills for the copays Inconvenient because you have to deal with 3 entities and 3 ID cards, i.e. Medicare, Supplement, and Part D plan

Convenient because supplements like Plan F will often cover all deductibles and coinsurance so there are no bills to pay even after a hospital stay or surgery.
Provider Choice PPO - Offers a lot of flexibility since you can see both in-network and out-of network providers.  Of course you pay higher copays going out-of-network

HMO - More restrictive since permission may be needed to see providers outside the network Gives you the most flexibility since you can see any doctor who accepts Medicare.  No need to worry about networks.

Acceptance

Cannot be denied (or rated up) for health conditions.  The only disqualifying health question is with regard to end stage renal disease (kidney failure) Medicare explained Cannot be denied when first turning age 65 and entering Open Enrollment Period .  If applying outside of that 6 month Open Enrollment window, health questions will have to be answered and you can be denied or rated up.