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Original Medicare

Original Medicare (Parts A and B) provides health insurance for citizens over the age of 65, younger individuals with disabilities and those with End-stage Renal Disease. Standard Medicare helps to cover the cost of hospital insurance (known as Part A) and medical insurance (known as Part B). Methods of covering the residual cost include enrollment in a Medicare Advantage Plan or a Medicare Supplement Plan. 

Medicare Advantage Plans

Medicare Advantage Plans (also known as Part C) are offered by Medicare and contracted private insurance companies. Part C delivers all the benefits of Part A and Part B. The majority of Medicare Advantage Plans also provide Part D (prescription drug coverage). 

Advantage Plans Enrollment Periods, Eligibility, Benefits and Costs

Enrollment Periods

You can enroll in a Medical Advantage Plan when you first become entitled to Medicare (during the 7-month initial enrollment stage), or on turning 65. There is also an open enrollment period that offers the opportunity to join a Medicare Advantage Plan. Special Enrollment Periods (allow you to make changes to your Medicare Advantage Plan), are provided in exceptional circumstances, such as moving into a new .

Enrollment Eligibility

To enroll in a Medical Advantage Plan, you must already receive Medicare Part A and Part B and must reside in the area covered by the plan provider. Those with End-stage Renal Disease are not eligible.

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Medicare Advantage Plans

Costs

Typically, you pay a premium for Part B plus a monthly premium for the benefits of the Medical Advantage Plan. Premiums vary and are set by the plan provider. The Medical Advantage Plan might include deductibles,coinsurance and, co-payments.

Benefits

The Medical Advantage Plan covers emergency and urgent care, hospital stays, outpatient care, doctor visits, home-care, tests, screenings, vaccinations, vision, hearing and, wellness care. Prescription drugs are often covered too.

Provision

Private companies contract with the federal government and offer their own Medical Advantage Plans (approved by Medicare).

There are a number of different plans available including Health Maintenance Organization Plans, Preferred Provider Organization Plans, Private Fee-for-Service Plans and Medical Savings Account Plans.

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Medicare Supplement Plans

Medicare Supplement Plans (also known as Medigap) are provided by private insurance companies. These plans are designed to help cover the health care costs that are not paid for by Original Medicare.

Supplement Plans Enrollment Periods, Eligibility, Benefits and Costs

Enrollment Periods

You are eligible to enroll in a Medicare Supplement Plan during the first 6 months of receiving Medicare Part B (medical insurance). You might be unable to enroll or be penalized if you attempt to enroll in a Medicare Supplement Plan after this time.

Enrollment Eligibility

If you are eligible for Part B, you are entitled to apply for a Medicare Supplement Plan (within the 6-month enrollment period). This includes those with pre-existing health conditions. After the initial 6-month enrollment period it is the decision of the private insurance company offering the supplement plan, to accept or decline the application. There are circumstances which would ensure eligibility for a Medicare Supplement Plan.

This applies to individuals below the age of 65 who are disabled, those with End-stage Renal Disease or those with proven medical problems. This would also apply to those who have additional insurance or the right to receive a Medical Supplement Plan (a guaranteed rights issue).

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Medicare Supplement Plans

COSTS

Medical Supplement Plan premiums vary and are set by the plan provider - Medicare does not contribute toward any of the associated costs.

Premiums are calculated in three different ways (Community-Rated, also referred to as no age-rated, issue age-rated and attained age-rated). The method of calculation changes the cost of the plan. The cost can also vary based on other factors, such as whether the insurance company offers discounts or uses medical underwriting. Due to the variety of plans on offer it’s wise to do your research before selecting a Medicare Supplement Plan

Benefits

All of the standard Medicare Supplement Plans must cover Part A coinsurance and any hospital fees, (for up to 365 days past the point when standard Medicare benefits end). Medigap plans may offer either 100% benefit or part benefit in terms of Part B coinsurance, Part A hospice coinsurance and the first three pints of blood.

Other benefits vary from plan to plan, some offer skilled nursing coinsurance coverage, Part A deductible coverage, Part B deductible coverage, Part B excess charge and travel outside of the USA coverage.

Medicare Supplement Plans do not provide payment for health care related to vision, hearing, dental, private-duty nurse provision or long-term care.

The difference between Medicare Advantage and Medicare Supplement Plans

Both Medicare Advantage Plans and Medicare Supplement Plans are available to people who receive Medicare, but there are differences between the two. As the name suggests, Medical Supplement Plans are intended to supplement (fill the gaps) and work alongside Medicare. Medicare Advantage Plans operate as stand-alone coverage, they act as a substitute for Medicare rather than a supplement to it.

The pros and cons of Medicare Advantage and Medicare Supplement Plans

Medicare Supplement Plans allow you to visit any doctor or facility that accepts Medicare. Medicare Advantage Plans require you to visit a doctor or facility from an authorized provider list, organized by region. This is known as a network-based plan.

You pay a monthly premium for Medicare Supplement Plans (depending on the plan provider), but there are few out of pocket expenses. With Medicare Advantage Plans the monthly premiums are generally very low, but you have higher out of pocket expenses.

Medicare Advantage Plans offer benefits such as vision and hearing care, along with added extras like gym membership. They usually also provide cover for prescription drugs. You will pay for a separate prescription drug plan with Medical Supplement Plans.

Medicare Advantage Plans limit you to healthcare providers in a regional area, with Medicare Supplement Plans you can receive care across the U.S, (with some plans making provision for foreign travel).

With Medicare Supplement Plans the annual benefits remain the same and providing you can afford the premiums your plan will last a lifetime. Medicare Advantage Plans have benefits and networks that can change annually. 

Take the time to research Medicare Advantage Plans and Medicare Supplement Plans, look at the options available and choose the best one to suit your needs. After all your health is the most important asset you have. 

Disclaimer

By completing the contact form on the site, you will be contacted by a licensed Medicare agent who can answer your questions and provide information about Medicare Supplement, Medicare Advantage or Part D insurance plans. Agents are not connected with or endorsed by the U.S. government or the federal Medicare program.