What’s Happening to Medicare Advantage and Medigap?

What’s Happening to Medicare Advantage and Medigap?

I find it surprising that over 48% of Medicare beneficiaries use Medicare Advantage to help cover the cost of care that traditional Medicare does not pay for.

And unfortunately, I also speak to many Advantage plan enrollees who are not sure if their coverage and other options.

Additionally, many of these enrollees really take the time to really compare the cost and fees of use when making their selection.

In fact, financial experts recommend a Medigap plan versus a Medicare Advantage plan based on the better coverage.

The ease of use and in a lot of cases, the overall cost savings.

I would like to walk you through the pros and cons of both and suggest that each of you consider more accurately, which is best for you.

Of course, if you are out of the issue period, you may not have a choice.

But for those of you who are approaching the initial enrollment period are healthy, then read on.

Medicare Advantage plans or government regulated plans that are known as part C, they have their advantages as well as disadvantages.

The advantages are many of the plans come with no or very low cost premiums.

Many Advantage plans also provide other perks such as vision, dental, gym memberships.

However, I must caution you, you'll always get what you don't or do pay for.

Disadvantages.

They limit your care to in-network providers often require pre-certifications to see a specialist and can be a time drain.

They can sell enrollees with high out-of-pocket costs for serious conditions that can be a detriment to older enrollees, as well as those with serious and complicated issues.

Complex plan offerings are not standardized across the country.

Plans are based on zip code equity, very overwhelming to get comparisons.

Additional costs for coverage and may have extra associated costs as its drug deductibles and specialist visits, co-pays, state-specific coverage offers the same coverage across the US.

However, Medicare Advantage plans may offer only specific coverage in specific areas.

So if you move to another area, your current Medicare plan may not be available.

Your Advantage Plan may not offer coverage when traveling.

Another problem is that some healthcare providers are beginning to drop some Medicare Advantage plans completely, or they may be considered now out-of-network.

The reasons for this are primarily due to long waits for free authorizations or denials and the reduction of physician payouts from Medicare.

My advice is to review your plans, their coverage, and choose wisely.

So how not to choose a Medicare Advantage or a Medigap plan?

Consider if you have an Advantage plan when in good health and everything is working out splendidly.

What may happen mid-year or any time you are out of the enrollment period and you now have become ill, especially if you have a serious illness such as cancer, you may not be able to switch to a Medigap or supplemental plan that may provide better coverage.

Don't allow the advertisers on TV to steer you to what is best for you.

Don't sign up for something simply because your neighbor or friend says what they have and they've been happy.

They don't know your current insurance needs, your medical condition, and neither can they predict your future needs.

Don't decide on premium alone.

Consider all the associated costs, the benefits and limitations.

The Medigap or supplemental coverage.

It’s extra insurance that you can buy from a private insurance company to help you pay your share of out-of-pocket costs in original Medicare.

Some of the advantages are if you had a role during your initial role, that period, when you have parts and part B, if you are covered through an employer plan and when you're role in Part B, you have a guaranteed issue, no matter your health status, your insurance could only be canceled due to nonpayment.

Standardized coverage.

There are ten Medicare supplement plans and 47 states that have exactly the same coverage.

Nationwide provider networks.

They use providers nationwide who accept Medicare.

No annual changes.

Medicare plans benefits rarely change, which to give you peace of mind and not have to review yearly.

It would generally take an act of Congress to make any changes.

Medigap plans do not have deductibles, all plans except plan A pay all or part of the part A deductible.

There is no co-insurance.

All plans cover part A and part B co-insurance cost.

All but three of the Medigap plans cover 100% of all copayments.

The three that don't have low copayments or pay 50 to 75%.

They cover the gaps in original Medicare, including deductibles, co-pays, co-insurance, blood and foreign travel emergencies up to the limits of the policy.

You can switch plans during your open enrollment period for another Medigap plan.

They are easy to budget.

You know what your costs will be.

All plans offer an additional 365 days in the hospital.

Some of the disadvantage that Medigap plans are is they cannot include extra benefits such as dental vision and hearing services or gym memberships.

After the enrollment period, you will have to go through underwriting.

It can possibly be turned down for coverage.

You may be delayed for up to six months if you don't have creditable insurance before signing up for Medicare, premiums will possibly be more expensive and rates can vary from state to state.

Not every Medigap policy has to be offered in every state, and policies can vary widely.

As you can see or have experience.

There are a lot of moving parts when deciding the best coverage for you.

Timing is also everything when it comes to coverage opportunities, taking the time to review your options, especially when new to Medicare can prevent a lot of headaches down the road.

And also reviewing your Medicare Advantage options yearly can help you uncover the best coverage for you.