MEDICARE

Before choosing a plan we want to be sure you know the difference between your many options; In particular how Medicare Supplement plans and Medicare Advantage plans differ, to ensure you get only the best coverage for you.

A Medicare Supplement Insurance plan, or Medigap, is used with original Medicare. It helps pay for costs that Original Medicare doesn’t cover, such as deductibles, coinsurance, and copayments. Any provider that accepts Medicare will take a Medicare Supplement plan because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Supplements do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP. (there are exceptions to this) A Medicare Supplement plan does not change year to year (although the cost does generally go up the coverage does not change).

  A Medicare Advantage plan is an alternative to Original Medicare and works differently than a Medicare Supplement plan. Medicare Advantage plans are created by private companies. You remain in the Medicare system, but Medicare is no longer responsible for your bills. These plans follow the same type of module as many group plans such as HMO or PPO. With this type of plan, it is important to remember several things.

First, most Medicare Advantage Plans have provider networks, so you want to make sure your doctor, hospital, and auxiliary care are within the plan’s network. Second, Medicare Advantage Plans have co-pays and other out-of-pocket costs such as coinsurance and deductibles associated with them. It is important to be aware of these because they can add up to be quite a bit of money. Third, most Advantage Plans have the Part D “built in”, which is a nice bonus, but you must be aware that when switching to a Medicare Supplement plan from an Medicare Advantage Plan, you will also need to enroll in a standalone Medicare Part D plan if you want prescription drug coverage. Medicare Advantage plans may have additional benefits that will vary depending on the plan selected.

Not all Plan D plans are the same. Although they are required to be at least as good as the Medicare model, they can vary greatly in costs, co-pays, specific drugs that are covered and can even vary from county-to-county in Pennsylvania. We strongly recommend that you talk to our team to help you choose the one that’s available in your area and best suits your needs.