What you hear and see is not always what you get.
Last week, two friends and I were discussing their Medicare coverage. Friend one told me she never pays anything when she goes to the doctor or hospital. Friend two said he pays all the time when he visits the doctor or hospital.Which one has the most cost effective plan?
Most people automatically think it’s friend one. Actually, the answer depends on proper analysis of all your medical factors by a qualified professional independent agent.
First let's decipher the confusion about Medicare Advantage and Medicare Supplement, or as some call them Medigap Plans. Yes, that’s right. Medigap and Supplement plans are the same!
Most people call any additional plan to basic Medicare a Supplement Plan, which is not correct terminology. While private insurers sell Medicare Advantage and Supplement or Medigap Plans, each can have a number of differences that can impact your out-of-pocket costs.Medicare Advantage Plans
The most appropriate way to understand the Medicare Advantage plans is to think of them as a pay as you go plan. Each time you visit your doctor or specialist, have a preventive or diagnostic test, or a hospital stay you make a payment.
The payments range from 0 to several hundred dollars depending upon the carrier and plan chosen, as each carrier has several Advantage plans in this area. Your cost will also depend on whether it's an office visit to a doctor (low cost) or a hospital stay (higher cost). The plan also might have a monthly premium, which is also carrier specific.
All Advantage plans have a MOOP, which is the Maximum Out-of-Pocket expense per plan year. The MOOP is also carrier specific.
Advantage plans use specific networks such as an HMO or PPO. Each carrier has their own network and some even have out of state coverage along with vision and dental coverage. In addition, your Part D prescription drug coverage is included in your Advantage plan.Medicare Supplement or Medigap Plans
Medicare Supplement or Medigap plans are the ones with the letters assigned to them Think of them as a pay in advance plans.
You pay a monthly premium to the carrier. Then, depending upon which letter plan you have either most, if not all, of your costs are covered in advance. Therefore, when you see the doctor or go into the hospital there is no cost to you.
There is also is no MOOP with these plans though some do have a deductible. You can go to any doctor or hospital in the US that accepts Medicare and you are covered.
In addition, if you have a Supplement or Medigap plan, you will have to purchase a separate Part D prescription drug plan as well, creating an additional monthly premium.
One of the most important things to consider about Supplement or Medigap plans is that each letter plan is regulated but the government so they are exactly the same in most states. However, there are large cost discrepancies from the carriers.Finding the Most Appropriate Plan
For example, this week I have worked with clients and simply had them change carriers in order to save a significant amount of dollars for the exact same plan. Think of it this way. The supermarket you’ve been going to sells your favorite brand of coffee for 8.00 a bag. Then, a new supermarket opens and has the same bag for 4.00 all the time. Where are you getting your coffee?
Now that we made Advantage plans and Supplement plans as easy as buying coffee, how do you find the most suitable plan for you or your family member?
This depends on a number of factors, such as current health status, frequency of doctor visits, prescriptions drugs being taken, and carrier choices in your area.
This brings us back to my strong recommendation from last week’s article about how confusing and daunting trying to research all of this by yourself can be. Instead of stressing, call an independent agent licensed and certified with all the carriers who can help you sort through all the noise.This article has been published in the Jewish Link (NY Metro), The Five Towns Jewish Times, and IMAGE Magazine. Robert Remin is an independent agent licensed and certified with all the Medicare carriers in the New York Metro area. As an unbiased resource, his only goal is to match you to the most appropriate plan. For any questions, or a cost free consultation, contact him at 914-629-1753 or email@example.com. Visit his website at http://www.robertremininsurance.com. He is also available for speaking engagements.