By Theresa Struckmeyer
Senior Health Insurance Specialist
Below are some reasons why choosing a Medicare Supplement Plan over a Medicare Advantage plan may be the best choice for those seniors who can budget the extra payment into their monthly expenses.
- Freedom: In my opinion this is the number 1 reason to choose a Medicare Supplement plan over a Medicare Part C plan. If you live in Southern California you should know that at this time all of the Medicare Advantage plans available are HMO’s. If you are used to a PPO, an HMO and its restrictions might be hard to get used to.
What is an HMO, you ask, and what are these restrictions I speak of? The first thing you have to understand is that you can only visit a doctor or hospital that is in the HMO network. You will be selecting a primary care doctor and that will be the only doctor you see unless that doctor refers you to a specialist and the health plan approves the referral. The specialist must also be part of the HMO network and on top of that the specialist must also work in the same network of doctors as your primary care doctor. What this means is if you have a specialist you like but your primary care doctor is not in the same doctor network, you cannot see that specialist even if the specialist accepts the health plan you selected. If you like to travel, you should also know that you will only be covered for emergencies outside of your local area since you can only see your primary care doctor unless you get a referral or there is an emergency. If restrictive rules like these make you want to shout, then chances are you need a Medicare Supplement Plan instead.
With a Medicare supplement plan there are NO NETWORKS or doctor referrals or anything like this. You can go to any doctor or hospital that accepts Medicare as payment. Let’s say you wanted to go to the dermatologist due to a rash or another Medicare covered type of condition. No need for a referral. Confirm your chosen dermatologist accepts Medicare and make an appointment. Ahhhh freedom and choice is such a breath of fresh air.
2. Everything is included (usually): The other nice thing about a Medicare Supplement Plan is the most popular plans cover everything or close to every Medicare approved expense that Medicare does not cover. The most popular plan, plan F, for instance covers all co-pays and deductibles for Medicare approved expenses. The 2nd most popular plan , plan G, covers all Medicare approved co-pays and deductible expenses except for the part B deductible which is currently $147 a year and slated to go up to $166 in 2016. Even though you will have the extra expense of a Medicare Supplement plan, you can easily budget as you will have very little, if any, extra expenses if you choose a plan like plan F or G.
Medicare Advantage, on the other hand, typically does not have a monthly cost associated with it; however, there are often co-payments for certain services with a certain maximum out of pocket as a limit on how much you pay in copays for a year. For instance, your maximum copays may be $3,400 for the year. Most likely you will not reach your out of pocket limit unless you have a very serious illness or situation, however, it does make it difficult to budget for medical expenses as it is hard to estimate what your monthly expenses will be.
- Easy to understand Plans and Benefits: Another nice thing about a Medigap plan is the benefits are regulated and easy to understand. Medicare Supplements are lettered from A-N. Each plan A is the same as another insurance provider’s plan A in that it has the same benefits and even the same network of available doctors and hospitals as the only network restriction you have to worry about is if the doctor or hospital accepts Medicare or not. This holds true for all of the plans from plan A-N. This means the only thing you have to worry about when finding a plan is selecting the benefit level you like and then finding the best insurance company to provide the plan. The main thing to look at is price as everything else about the plan is the same regardless of which health plan company you select.
Medicare Advantage plans are a little more complicated in this respect as the first thing you need to consider is the doctor/hospital network. Each plan’s network is unique. You also need to consider the benefits offered. Remember the co-pays will vary with Medicare Advantage so you need to consider this closely. Lastly, each health plan’s benefits change each year so even if you are comfortable with your benefits now, those benefits can change. If you love your doctor, you should also note that an HMO’s doctors network is not set in stone so you will either have to find a new plan or a new doctor if the network changes and your doctor is no longer in network.
Every senior’s needs are different. Have a question? We are here to help! We are just a phone call 1-855-731-8888, email, or online chat away. We have been helping seniors with their insurance needs since 1995 and would love to help you as well!
MP Insurance Solutions is a Senior Health Care Insurance Brokerage. We specialize in Medicare Supplement/ Medigap plans, Medicare Advantage/Medicare Part C, Prescription Drug Plans/Medicare Part D, Senior Term Life Insurance, Final Expense Insurance, guaranteed income annuities, and dental and vision plans. We specialize in helping seniors in Southern California including Los Angeles, Riverside, San Bernardino, San Diego, and Orange County California.