Medicare Supplements

MEDIGAP

Plans

Medicare Supplement plans, also known as Medigap plans, are insurance policies sold by private companies to help cover some of the out-of-pocket costs not covered by Original Medicare, such as deductibles, copayments, and coinsurance. These plans are designed to work alongside Original Medicare (Part A and Part B) and are standardized by the government, meaning the coverage remains the same regardless of which insurance company you purchase the plan from.

There are several standardized Medicare Supplement plans, each labeled with a letter (A, B, C, D, F, G, K, L, M, and N). Each plan offers a different combination of benefits, with Plan F being the most comprehensive, covering almost all out-of-pocket costs.

It’s important to note that Medicare Supplement plans do not cover services like vision, dental, or prescription drugs, so you may need to purchase separate insurance policies for those needs.

Overall, Medicare Supplement plans provide peace of mind by helping to reduce the financial burden of healthcare costs not covered by Original Medicare.

Medicare Supplements

BENEFITS

Peace of Mind

Knowing that you have access to a wide range of healthcare providers without worrying about network restrictions can provide peace of mind, especially if you have complex healthcare needs or prefer to see specific doctors or specialists.

Consistency of Coverage

Since Medicare Supplement plans are standardized by the federal government, the coverage remains the same regardless of which insurance company you choose. This means that as long as you continue paying your premiums, you can rely on consistent coverage for your healthcare needs, regardless of changes in your healthcare providers or locations.

No Referrals Needed

You don't need a referral from a primary care physician to see a specialist with a Medicare Supplement plan. As long as the specialist accepts Medicare, you can schedule appointments directly without going through a referral process.

MEDICARE ADVANTAGE PLAN TYPES

Medicare Advantage Plans have networks, which are lists of doctors and hospitals who participate in the plan. These networks can give Medicare Advantage members convenient access to medical care at reasonable costs. There are various types of Medicare Advantage Plans and the two most common are HMO’s and PPO’s. Here are the key features and differences between the two types of plans.

PPO – Preferred Provider Organization
HMO – Health Maintenance Organization

MEDICARE ADVANTAGE VS ORIGINAL MEDICARE

As mentioned above, you have two ways to receive your primary Medicare benefits; Medicare Advantage and Original Medicare. The chart below gives you a comparison of the main features.

Feature
Original Medicare
Medicare Advantage
Total Monthly Cost Estimate
$164.90 in 2023
$104.90 – $164.90 in 2023
Part A & B Medical Included?
Yes
Yes
Cap On Annual Medical Bills Included
(Max out of pocket protection)
No, you can buy a Medicare Supplement (Medigap)
Yes
Doctor Networks
No – Open
Yes
Pharmacy Benefits (Part D)?
No, you can buy a Part D plan.
Yes, Part D is usually included, unless you choose a plan without it.
Dental, Vision, Hearing
No
Yes, typically included.
Fitness Membership
No
Yes

SAMPLE MEDICARE ADVANTAGE PLAN

What A Typical Medicare Advantage Plan Can Look Like
Benefit
Copy or Allowance
Annual Deductible
$0
Preventive Medicine
$0 copays
Doctor Visits
$5 Copay Primary Care
$30 Copay Specialist
Outpatient Surgery & Procedures
$150 – $300 copay
Hospital Stay
$100 – $300 copay per day for days 1-5, $0 copay each day above 5
In Network Max Out Of Pocket Protection
(The most you pay for medical care annually)
$3,400 – $6,700
Pharmacy Benefits (Part D)?
Generic: $0 deductible / $0 – $10 copay
Brand: $0 – $200 deductible / $40 copay
Dental
Coverage for cleanings, fillings, crowns, dentures, and other services, $2,000 – $3,000 in annual benefits
Vision
$0 cost annual eye exam, $200 allowance for eye glasses or contacts.
Hearing
$0 cost annual hearing exam, allowance or copay for hearing aids.
Gym / Fitness
Silver Sneakers membership for free access to participating gyms
Other Possible Benefits
Over the counter medicine & vitamins, flex spending cards, transportation.

*The benefits and comparisons listed in the two charts above are for general information purposes. They do not represent specific plans and benefits are not guaranteed. For plans you are considering, review the Summary of Benefits and Evidence of Coverage. Contact us for specific plan options available to you.

WHO CAN BENEFIT FROM MEDICARE ADVANTAGE?

Frequently Asked Questions

When can I sign up for a Medicare Advantage Plan?

There are two primary periods when you can enroll in a Medicare Advantage plan. 1. When you first start Medicare A & B. 2. During the Annual Open Enrollment period which begins October 15th and lasts through December 7th. There may also be other special situations that make you eligible. To get information and enroll in a plan, simply contact us on this site or give us a call at 855.625.7633 toll free.

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