Medicare Supplements vs. Medicare Advantage
If you are eligible for Medicare, you may be looking for ways to lower your overall health care costs. Well, Medicare beneficiaries have some unique options for optimizing their coverage.
Two major examples are Medicare Supplements and Medicare Advantage plans. While the two plan benefit structures are totally different, they both provide one similar advantage. Each plan provides a known maximum liability for any major illnesses or accidents in any one given year. This peace of mind is worth every penny one spends on their health care.
What Are Medicare Supplements?
Medicare Supplement Insurance exists to fill the gaps that are left behind by Original Medicare. These gaps are typically out-of-pocket health care costs that remain after Medicare pays their approved portion of health care costs, and Medicare Supplement Insurance plans cover some of those costs for you.
Types of Medicare Supplement Plans:
We typically divide Medigap plans into three different categories; basic, comprehensive, and cost-sharing. The basic plans cover minor costs, such as Part A coinsurance for hospital stays. Comprehensive plans cover a far wider range of costs, including deductibles, excess charges, and even foreign travel emergency care. Cost-sharing plans are the most unique option, as they only pay a portion of some out-of-pocket costs, leaving you to pay the rest until you reach a defined known maximum out of pocket limit.
There are no networks other than a doctor acceptance of Medicare as primary coverage. This gives more choice than those Medicare plans who only offer local or regional doctor networks.
What Is Medicare Advantage?
Medicare Advantage provides an alternative to Original Medicare. Original Medicare offers Part A and Part B health insurance, and Medicare Advantage plans offer benefits equal to or better than Original Medicare. Medicare Advantage Plans are considered Part C of Medicare and must follow guidelines as well as have plans approved through the Centers of Medicare and Medicaid.
Medicare Advantage plans replace Medicare Part A and Part B; however, beneficiaries must maintain their Medicare eligibility to join and remain on a Medicare Advantage plan. Through a federal contract, insurance companies receive a monthly payment for each beneficiary enrolled into their plan. It is this payment plus managed care cost savings that allow health insurance companies to offer low or no premium plan options with additional benefits like dental, vision, hearing aids, over the counter items, gym memberships, and transportation.
Networks are set up with doctors’, hospitals, and pharmacies with pre-negotiated rates, providing additional savings to the plan and their members health care costs. Medicare Part C plans provide a wellness program for better health care outcomes as well as a strong checks and balance system on duplicate and billing overcharges that is unmatched by Original Medicare. These cost savings continue to provide resources needed to keep ancillary benefits not covered by traditional Medicare a vital part of members health care plans.
Medicare Advantage Benefits
Health care costs continue to rise each year with what seems like no plan of action to reign in costs. Medicare Advantage plans are innovative and beginning to drive an awareness to the need to get better health care outcomes. The MCO Manage Care Model provides healthcare benefits for Part A & B and often Part D medications under one simple plan. Additional ancillary health benefits not covered by Original Medicare are repeatedly covered benefits like dental for good oral health, vision, hearing aids, gym membership and medical response systems all focused on the patient needs there by addressing and improving health care outcomes.
Medicare Advantage companies are implementing wellness and advocate programs that address immediate and preventative health and lifestyle needs. Wellness programs that incentivize members with cash or redeemable credits when they engage and timely keep recommended annual physicals, mams, PSA tests, colonoscopies, preventative testing etc. Most companies have optional in-home house calls with a registered nurse to give in-home testing and care with education on how best organize their daily routine, medicines, and lifestyle challenges. Improved health care outcomes are so dramatic with these services that companies are giving small $15-$25 gift certificates to members for their time and participation.
To learn more about Medicare Advantage Part C plans (the fastest growing Medicare plan offering), give Larry Klein a call 515-664-7078, he has worked with Medicare Advantage plans since 2006.
Now That You Know The Difference, Start Shopping
Hopefully, we have provided information that will help you in your understanding of the two most prominent ways to handle your Medicare insurance. Neither option is better than the other; they are just different in how they approach your health insurance coverage.
We are unbiased to an individual’s personal choice and type of plan they feel most comfortable with. We carry nearly every Medicare plan option available and would love to represent your Medicare plan needs. Please call so we can assist you today.