Medicare Insurance Long Beach California

What is the Difference Between Medicare Advantage vs Medicare Supplements?

When you are new to Medicare, it is crucial to understand the difference between a Medicare Advantage Plan and a Medicare Supplement plan also known as a Medigap plan.  Picking your Medicare insurance coverage is critical to your health and well-being. You have alternatives when it relates to Medicare coverage, which is beneficial and yet can be overwhelming. 

Original Medicare covers your essential outpatient and inpatient medical requirements, known as your Part A and Part B coverages.  In addition to Part A and Part B, you must sign up for Part D, your prescription drug coverage.  You may wish to add insurance for vision and dentistry or self-insure these two items.

You’ll also have to pay insurance premiums, copayments, deductibles, and co-insurance related to your medical expenditures if you only have Original Medicare.  Due to the gaps left behind by Original Medicare, you must decide whether to purchase a separate Medicare Supplement, aka Medigap plan, or leave Original Medicare and sign up for a Medicare Advantage Plan.  While these two choices may not seem like significant decisions, your choice can majorly impact your overall healthcare options.

Future Outlook of Advantage Plans



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Medicare Advantage Plans: What You Should Consider

Private insurance companies offer Medicare Advantage plans.  It is an alternative to obtaining your health insurance coverage through Original Medicare. Here’s a rundown of Medicare Advantage’s benefits, prices, and eligibility requirements. These plans include everything that Original Medicare does, such as:

Based on your Medicare Advantage plan, you might also be covered for:

  • Basic Dental with options to purchase a compressive plan
  • Basic Vision
  • Subscriptions at gym
  • Travel expenses covered to and from doctor visits
  • Help with your Pet
  • Pest control
  • House Keeping
  • Groceries

What is the Cost Associated with Medicare Advantage Plans?

Medicare Advantage rates, like every insurance program, vary based on the available insurance companies, the location of your home, and the plan you select. While we understand the cost may be your primary focus related to a monthly premium, other costs also need to be considered.

Expenses such as deductibles and copays will also vary depending on the plan. As your Medicare Advantage plan only includes one Part D prescription drug plan, you must also compare this cost between plans and insurance companies.

Following are a few Factors that will impact your Medicare Advantage plan costs throughout the plan year:

  • Frequently of use?
  • Copays
  • Deductibles
  • Co-insurance
  • Annual Max Out-of-Pocket Cost: Plan Year 2021
    • HMO Plans: Up to $7,550 in-network and 100% of cost out-of-network
    • PPO Plans: Up to $7,550 in-network and $11,300 out-of-network
  • Where you obtain your treatment (in-network or out-of-network)
  • Your annual income
  • If you get financial help such as Medicaid or if you have a handicap

As mentioned, most Medicare Advantage plans will include your Part D prescription drug coverage.  It is essential to factor in the drug cost associated with each plan.  This includes what tier each prescription drug falls under and the related copy or co-insurance.

Qualification for Medicare Advantage

To sign up for Medicare Advantage, you must meet the following requirements:

  • You must sign up for Medicare Part A and Part B before enrolling into a MAPD plan or a Medicare Supplement Plan.
  • You must reside within a Medicare Advantage provider’s service area that offers the medical services you choose and is enrolling new customers during your registration period.


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What You Should Consider About Supplement Plans for Medicare

A Medicare supplement policy, aka Medigap plan, does not require you to leave Original Medicare but rather fill in the gaps.  These insurance policies allow Medicare Beneficiaries to establish a monthly budget related to their health insurance cost with no surprises.  The US Government regulates these plans and is not permitted to change from year to year.  

While a Medigap plan is optional, it is highly recommended so you are not faced with medical bills that can total millions of dollars.  Find out more about Medigap insurance, pricing, and qualifications in the sections below.

Medigap Chart 2021

Medigap Insurance

Medigap insurance helps cover the expenses not covered by Original Medicare. These expenses might include:

  • Deductibles, Coinsurance, and hospitalization fees under Medicare Part A
  • Costs associated with Medicare Part A hospice reimbursement or co-payments
  • Costs of Medicare Part B deductibles, coinsurance, and copayments
  • Costs of blood transfusions for the first three pints
  • Deductibles and co-pays for skilled nursing facilities
  • Excess charges allowed under Medicare Part B
  • Emergency Medical expenses incurred while travelling abroad

There is a total of ten Medigap plans that are currently available.  These plans are identified as an individual letter.  The ten letters are Plans A, B, C, D, F, G, K, L, M, and Plan N.

Part B deductibles can no longer be covered by newly acquired Medigap policies starting on January 1, 2020. Should you turn 65 years old and become eligible to enroll in Medicare in 2020 or later, you cannot acquire Plan C or Plan F, depending on which of these two plans are available in your State. These two plans are still available for Medicare Beneficiaries who turned 65 before January 1, 2020 and wish to enroll in one of these plans.

How Much Do Medigap Insurance Policies Cost

The cost of Medicare insurance is determined by your qualifications and the sort of protection you choose. The more protection you desire, the more expensive Medicare Supplement packages get. Furthermore, the older you are when you join, the higher your cost will be. The following factors may affect the prices of your Medigap insurance:

  • Current Age (the older you are, the higher the insurance premium will be each year)
  • The Medigap Plan you Select (Plan F vs Plan G vs Plan N)
  • Eligibility for discount
  • Medical Conditions if outside of your Guaranteed Eligibility Period

Eligibility for Medigap Coverage

You are eligible to apply for Medicare during your initial enrollment period.  This period starts three months before turning 65 years old, the month of your 65th birthday, and three months after your birthday.  During this time, you are able to enroll in a Medicare Advantage plan or remain on Original Medicare and purchase a Medigap insurance plan. 

During this 7-month window, you are in your guaranteed issue period.  This means Medicare supplement insurance companies cannot base their premiums on your current health conditions.  In addition, during this period, they cannot turn you down for coverage.  To sign up for a Medigap plan, you are required to sign up for Medicare Part A and Medicare Part B.

Medicare A,B,C,D

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What are the differences between Medicare Advantage Insurance and Medicare Supplement Insurance?

Medicare Advantage

Private insurance companies provide Medicare Advantage plans.  The government pays these Medicare Advantage insurance companies a fixed monthly amount for each Beneficiary that joins these plans.  In doing this, the government caps its losses and transfers the risk onto private insurance companies to manage your healthcare needs. 

When you join a Medicare Advantage company, you agree to relinquish your rights under Original Medicare and transfer those rights to the private health insurance company.  This can mean being limited to a network of doctors, hospitals, and medical facilities.  In addition, you agree to have copays, coinsurance, and deductibles along with a max out-of-pocket cost.

You will be limited to a single Part D prescription drug plan under the Medicare Advantage plan.   Medicare Advantage plans are also known as Part C designs.

Medicare Supplement Plans

Medicare Supplemental insurance, commonly known as Medigap, is a plan that private health insurance companies also provide.  Unlike Medicare Advantage plans, you do NOT relinquish your rights under Original Medicare when purchasing a Medigap plan.  Instead, you remain on Original Medicare. Depending on your plan, the Medigap plan must pay for the things not fully covered by Original Medicare up to 100% of the total cost. 

Medicare Supplement plans are all standardized and do not change from year to year.  This means that your Medigap plan, once you sign up for a plan, will remain the same forever. 

If you remain on Original Medicare and obtain a Medigap plan, you must also purchase a Part D prescription drug plan.  In doing this, you can access dozens of Part D plan options from multiple Medicare insurance companies.

As you have remained on Original Medicare, you do not need to obtain referrals to see outside doctors, and you can see any doctor or medical facility that accepts Medicare.

Checklist Difference Between Medigap and Advantage Plans

Are Medicare Advantage or Medigap plans better for you?

Knowing your medical needs will help your Medicare Insurance Agent determine the best option. When determining between Medicare Supplement or Medicare Advantage is best for you, consider the following:

  • A Medicare Advantage plan may be your best option if you are looking for more pay-as-you-use-it plans. Many of these plans may not have a monthly premium, low co-payment, deductibles, and co-insurance up to a maximum out-of-pocket cost.  These plans can offer additional benefits such as vision, dental, and hearing aids.  Most of these plans are HMOs and will require you only to use Doctors within their plan’s network.
  • If you like the ability to see any Doctor and not be tied to a network of Doctors, a Medigap plan may be better suited for you. In addition, depending on the Medigap plan you select, you can avoid the backend costs associated with using your plan, such as higher deductibles, co-payments, and co-insurance. With a Medigap plan, your medical cost can be fixed monthly, allowing you to budget your insurance cost.  Some Medigap plans include additional benefits such as gym membership.
  • If you travel a lot and want the flexibility to see Doctors outside of an emergency, a Medigap plan would work best for you. A Medicare Advantage plan would not allow you to see Doctors or Medicare Facilities that are outside of your Network for non-emergencies.


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Is it possible to have a Medicare Advantage and a Medicare Supplement plan simultaneously?

There are two forms of Medicare programs: Medicare Advantage and Medicare Supplement plans. It is not allowed to have both a Medicare Advantage plan and a Medigap plan simultaneously. 

Can I switch from a Medicare Advantage Plan to a Medicare Supplement Plan at any time?

You can switch your Medicare coverage during your Annual Enrollment Period, which extends from October 15th to December 7th of every year. Throughout this time, you can switch from a Medicare Supplement coverage to a Medicare Advantage program if you want to. 

Please keep in mind that when disenrolling from a Medicare Advantage Plan to a Medicare Supplement plan outside of your guaranteed issue period, you will be required to go through full medical underwriting.  The Medigap company can deny your coverage depending on your medical conditions.  You can switch from a Medicare Advantage plan to another Advantage plan without medical underwriting.

What are the advantages of Medicare Advantage vs. Medigap?

Medicare Advantage Plans

Let’s start with the advantages of Advantage plans. Part C strategies appear to be an all-inclusive plan that can provide all required coverages to avoid penalties. These plans are known in the insurance industry as MAPD plans, as they include your required Medicare and Part D coverage under a single umbrella.  In addition, some plans include extra benefits for joining their plan that may or may not be included with a Medicare Supplement plan. 

Remember that under a Medicare Advantage plan, you are locked into a local network of Doctors, Medical Facilities, and Hospitals.  If you obtain medical attention that is not an emergency, these services may not be covered even if these Doctors accept Medicare.  Before joining a Medicare Advantage plan, you have six different Doctors.  It may be possible that no Medicare Advantage plan will cover all these six Doctors, and you will be required to pick new Doctors under that network. 

With these plans, you must have pre-authorization before your doctor or hospital can complete a procedure.  These authorizations have been known to take weeks or longer.  In addition, your Advantage plan Carrier can deny coverage that Original Medicare would have otherwise covered with a Medigap plan.    

Medicare Supplement Plans

Perhaps we might look at the benefits of Medigap insurance plans. Medicare Supplemental insurance allows you to see any doctor in the United States who accepts Medicare, which equals about 98% of all Doctors in the USA. With a Medigap insurance plan, you’ll never need a recommendation or preauthorization to see a specialist or have a medically necessary procedure. Your doctor, not the health insurance company, can decide what is medically necessary.  Furthermore, Medigap covers international travel situations, additional hospital stays, and coinsurances you would otherwise have to cover. Medigap plans give you, as the patient, the freedom of choice and the Doctor the ability to do their job without weeks or months of delays.

Medicare Supplement plans are standardized, which means they never change.  Unlike Medicare Advantage plans that change yearly, you are not required to review your Medigap plan each year as their coverages do not change.


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What are the Disadvantages of Medicare Supplements vs. Medicare Advantage

Disadvantages of Medicare Advantage  Insurance

Medicare Advantage plans can appear to be enticing on the outside. Many Medicare Beneficiaries who have never experienced a Medigap plan will typically rave about their Medicare Advantage plan.  This is primarily because they are relatively healthy. 

As most Advantage plans are HMO plans, you are limited to a few doctors, medical facilities, and hospitals to choose from.  This means if you get cancer, you will not be allowed to seek help from some of the top cancer facilities as they do not accept Medicare Advantage plans.  They only accept Original Medicare with a Medigap plan.  Many people only discover this once they become sick, not when they are healthy.  As a result, you may be able to afford to pay the entire price for out-of-state treatment or out of your local county service area.

The advantages are minimal, even though they may cover basic Dental, Vision, and hearing aid coverage this should not be the reason you go with these plans.  Most plans do not cover full dental treatment or the full cost of a hearing aid.

While most Medicare Advantage plans include Part D coverage, they only give you one option.  This can end up costing you thousands of dollars in prescription drug costs. 

Most Advantage plans may also require a referral from our primary care doctor to see a specialist.  They will also require pre-authorization for medical treatment, which can take several weeks, depending on the medical procedure, while you are sitting there in pain.

Disadvantages of Medicare Supplements

The list of disadvantages for Medigap is now significantly shorter. Part D and other auxiliary coverages are not included in Medicare Supplement plans and must be obtained separately. The primary complaint we hear is usually about the monthly premium that Medicare Beneficiaries have to pay.   They hear from their neighbor that they don’t pay for their Medicare Advantage plan, and they start to wonder why they have to pay a monthly premium. 

What you should know about Medigap insurance

Parts A and B of Medicare are required before signing up for a Medigap plan. Medigap coverage differs from a Medicare Advantage Plan in several ways. Medigap insurance complements your Original Medicare coverages, whereas Medicare Advantage plans require you to give up your Original Medicare rights and transfer them to the insurance company.

A private insurance provider charges you a set monthly premium for your Medigap coverage. This monthly plan is in addition to the Part B payment you pay into Social Security every month. Only one individual is covered by a Medigap plan; however, if you and your spouse are signed up with the same company, you may qualify for a discount. You can also buy different insurance if you and your partner want Medigap insurance, and another Medicare insurance company offers your spouse a lower rate than yourself.

Medigap coverage can be purchased from a range of insurance providers that are registered and licensed to offer them in your region. Even if you have health issues, any standardized Medigap coverage is guaranteed renewalable once you are covered by a Medicare Supplement plan. This implies that your Medigap coverage will not be canceled as long as you pay the premiums.

Prescription medications are covered by several Medigap plans offered in the past. However, Medigap policies sold after January 1, 2006, do not permit prescription medication coverage. It is essential to sign up for a Medicare Prescription Drug Plan if you need drug coverage (Part D) to avoid penalties. If you purchase Medigap and Medicare drug coverage from the same firm, you may be required to pay two premiums. If you’re under a Medicare Advantage Program, it is unlawful for anybody to offer you another Medigap coverage or a separate Part D plan.


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Side by Side Comparison of Medicare Advantage Plan and Medicare Supplement Plan

On the other hand, Medicare Advantage programs are an option to Original Medicare. You’re still enrolled in healthcare if you choose a Medicare Advantage plan. Nevertheless, rather than receiving Medicare benefits via the nationally managed program, you’ll receive them via your Medicare Advantage plan, which will take over the role of your Original Medicare program.

 

Medicare Advantage

Medicare Supplement

Can make changes

Required to review Every year, as coverages may increase & decrease each year

Unless there are exceptional conditions, just once in a lifetime, coverage remains the same and never changes from year to year.

Monthly premium

As low as $0 and as high as the insurance company can charge.

Usually, it has a monthly premium based on age and geographical location.

Deductibles

It depends on the Plan you select, if it has a deductible, and the amount.

Unless you get Plan F or C before the start of  the year, you will have an annual deductible for Part B of $203 (2021 plan year)

Premium Part B

Mandatory

Mandatory

Drugs & Prescriptions

One option Included with the MADP plan

Obtained Separately with hundreds of options

Restrictions for service providers

Yes

No

Max Out-of-Pocket Cost

Up to $7,550

Most plans have no out-of-pocket cost.

Standardized benefits

Not Available: coverage changes yearly.

Yes, coverage remains the same each year

Co-payments and co-insurance

Co-payments and coinsurance are always required.

May cover all co-payments and coinsurance

Which one is better?

Your health insurance needs will determine if you should sign up for a Medicare Advantage or a Medicare Supplement insurance plan. When considering if Medicare Advantage or Medicare Supplement is preferable for you, consider these:

Do you want all your insurance under one plan and for the insurance company to decide what is covered? A Medicare Advantage Plan could be the best option if this is the case. Depending on circumstances, many provide Part D medical insurance and additional benefits not included with Original Medicare.

Do you want to be protected against out-of-pocket expenses like deductibles, co-payments, and coinsurance? Suppose you have Original Medicare and purchase a Medicare Supplement plan. In that case, these plans can assist in covering some or all of the outstanding out-of-pocket expenditures that regular Medicare does not cover.  With these plans, you will have a yearly budget for your medical costs.


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Integrity Now Insurance Brokers wants to be your Medicare Insurance Agent

When selecting which Medicare Insurance plan is best for you, we are here to help you navigate it all.  As you can see, there is no one best plan.  Each Medicare Beneficiary we talk with has different medical needs and must have Doctors and hospitals.  What is right for one person is not suitable for the other. 

Integrity Now Insurance Brokers is centrally located in Long Beach, CA, and is here to help you no matter which state you are located in. Please call, and we will help you find the Medicare Plan that works best for you.

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