Wondering how to choose the best Medicare plan for you? It can be a big decision, and it's not one to be taken lightly. Medicare only covers about 80% of your healthcare costs. You will be responsible for the other 20% as well as deductibles and copays.
Though both policies help you cover your gaps in Medicare, they are designed very differently.
Medicare supplements pay as a secondary insurance to Medicare. This means they pay after your Medicare first pays its portion of the bill. You stay enrolled in Medicare, and Medicare sends the remainder of your bills to your Medicare supplement company.
Medicare Advantage plans, on the other hand, are entirely separate from Medicare. When you enroll into a Medicare Advantage plan, you get your benefits from the plan, not Medicare. You agree to use the plan’s network of providers except in emergencies. You’ll pay copays for your health care treatment as you go along. Think of these plans as an alternative to Original Medicare.
Let’s explore a bit more about each type of plan.
Medicare supplement plans are also called Medigap. Having a Medigap plan means you are still enrolled in Original Medicare as your primary insurance. You can see any provider that participates in Medicare, regardless of which supplement company you chose.
You have access to all the Medicare providers nationwide – no referrals necessary. If you enroll in a comprehensive plan like Plan F or Plan G, you will have very little out of pocket. Not even doctor copays!
When you enroll, your Medicare supplement insurance company notifies Medicare that you have enrolled. Thereafter, when Medicare pays its portion of your bills, it will automatically send the remainder of your bill to your Medicare supplement company. It’s seamless, with no claims forms for you to file.
Medicare supplements also offer you the most freedom. You have freedom to choose your own doctors and hospitals from among the 800,000+ Medicare providers in the nation. No referrals are necessary to see a specialist.
Because these plans offer you the most freedom and flexibility, they have higher premiums than Medicare Advantage plans. It depends on which Medigap plan is chosen and whether that individual uses tobacco. Plans and rates vary by region, age and sometimes gender.
Medigap plans cover medications administered in a hospital setting, such as injectables or chemotherapy drugs. They do not cover retail medications though, so most beneficiaries will enroll in a separate Part D drug card.
If you enroll into a Medigap plan during your one-time open enrollment window (within 6 months of your Part B effective date), there are no health questions. The insurance company will approve your application. There are no waiting periods or pre-existing condition exclusions. If you miss this window and apply later on, then you must answer medical questions and be underwritten.
About 30% of beneficiaries choose Medicare Advantage plans, which are private insurance plans. They usually have lower premiums than Medigap plans. Sometimes even a $0 premium on some plans in some areas. No additional premium after you pay your Part B premiums monthly. Why? Because you agree to use the plan’s network providers to get your care. This means you’ll have substantially fewer doctors to choose from than if you chose a Medigap plan.
It’s important to check with your doctors first to see if they are in the network. This is especially important if the Advantage plan you are considering is an HMO, which often have the smallest networks.
Your Medicare Advantage plan will pay your healthcare bills instead of Medicare paying them. You will pay copays for the services you obtain from providers in the plan’s network as you go along.
You must be enrolled in both Part A and Part B and continue to pay your Part B premiums to be eligible for a Medicare Advantage plan. There is also one health question about End Stage Renal Disease (ESRD). People with ESRD do not qualify for Medicare Advantage plans.
Boomer Benefits provides free claims support for life for all of our Medigap and Medicare Advantage policyholders so that you are never alone in dealing with Medicare.
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Wow! This makes my decision super easy – Medigap for sure.
Both of my parents went with Plan G and pleased so far
Question for you… if a beneficiary (my grandmother is located in Georgia) realizes AFTER choosing a Medicare Advantage plan that they would prefer to have a Medigap plan, are they stuck?
No she isn’t stuck. There are a few ways she could get a Medigap plan. For instance, if she is still within her first year of Medicare, she can join a Medigap plan by way of guaranteed issue.
I have medical plan F, but after Medicare pays, I get a balance from the doctor. My Medicare. Gov shows that supplement did not pay all. Why am I getting a bill? I thought I would never get a bill. Please explain this for me.
If Medicare pays, your Medigap plan should pay. If Medicare denies a claim, then your Medigap plan will deny it as well. After Medicare pays their part, they send the bill to your Medigap plan. They will see that Medicare paid, and then they will pay their part. If you were a client of Boomer Benefits, we would be able to contact your plan provider to straighten this out. If not, you will need to contact you plan provider yourself to see what’s going on.
My mother has Medicare, can she apply for Medicaid to pay for that premium $135 because when that payment comes out she only have $ 483 monthly which does not help with her expense. What can she do to pay half or help with premium.
Hi Kayse – Each state has their own rules on who is eligible for Medicaid. She will need to call your state’s Medicaid Office or look on their website to see what she needs to do. Attached is a link with a list of some things your mother can apply for to get help with Medicare premiums. https://www.medicare.gov/your-medicare-costs/get-help-paying-costs
Can I dis enroll on plan f and change it to plan g? Thanks
Yes you can. You can apply to change Medigap plans at anytime throughout the year. However, you may have to answer health questions to do so. We go over the carriers health questions with the client prior to applying to see if we feel they have a good chance of being approved.
Boomer Benefits what if i get disapproved on plan g, can I still go back to plan f? Thanks
Luis Abiera we would not cancel your Plan F until you get approved for Plan G. This is how we ensure that you don’t have any chance of being without coverage
+Luis Abiera You would apply for your Plan G first. If you are approved, then you’d cancel your Plan F.
Your audio is only on the left side
Have you ever had someone that got a medigap plan and ended up being to tight so they went to an advantage plan?
Yes. In a situation like this, if you are outside of your initial election period, then we would wait until the AEP that starts in October to enroll in a Medicare Advantage plan. Or if you started with a Medigap plan and found it to be too expensive, you can easily switch to a Medicare Advantage plan during any annual election period.
Really great breakdown of the plans. Thank you for posting!
In the times we’re living all Insurance should be free government should pay for its socialistic program it’s a good socialist Tech program not a bad one they’re stealing all of our tax dollars out of our hard-earned money and giving it to the rich people and then the rich people don’t even want to give the long hard laboring people that build the highways and hospitals and their fancy mansions and Towers any money they want us as slaves so by God give us some freakin free insurance we can’t afford even to buy a new car free free free let the billionaires and trillionaires because that’s what they’re going to be soon trillionaires let them pay for the infrastructure and let them pay or at least help to pay for the masses insurance if they’re not going to give us any decent wages
My wife is on SS disability and has Medicare A & B. She has been enrolled in Medicare since 2005. I have insurance where I work and currently she is on that plan with me and her Medicare is the secondary insurer, covering all co-pays, etc.. I am retiring at the end of 2020 and will be signing up for Medicare and plan on getting a gap plan for myself. Can my wife also get a gap plan once I drop my employer insurance?
Yes she will be able to transition over to Medicare as her primary coverage at the same time. If she is still under 65, her options for supplemental coverage will depend on her state. Some states have Medigap carriers that sell plans to people under 65 and some states do not require that. Be sure to check on pricing as Medigap plans for people under 65 can often be more expensive since the carriers know that anyone on Medicare under 65 has a disability that may require frequent healthcare services. If you are unable to find an affordable Medigap plan for her, consider a Medicare Advantage plan as those have the same price for everyone regardless of age. Later when she turns 65, she will have a second open enrollment period for Medigap as well so she could get a Medigap plan then without underwriting.
Super informative videos, THANKS! Am I allowed to transfer my Medigap plan G to your agency? I’d like the to use your vast knowledge and experience in the future? I am beyond the six month trial period for signing up. Also, I have a congenital heart valve problem that may?? be a problem with health questions if I were to switch providers of my plan G. But, I would be happy to stay with my current provider, UnitedHealth, AARP, AND switch to BabyBoomers. (I wish I knew about you more than a year ago. Shoulda, woulda, coulda.)
Hi Mark, we are so happy to hear you want to make the switch to Boomer Benefits. Give us a call at 817-249-8600 and you can talk with an agent to figure out if you would be able to pass underwriting.
Good presentation – nicely done.