It’s often confusing, especially for someone new to Medicare, to understand the choices between picking a Medi Gap + Part D Rx plan or going to a Medicare Advantage plan, generally including prescriptions and often a zero premium. Both options require that you first sign up for Medicare A Hospital and B Doctor Visits.
Three main options:
Basically pays the Part A Hospitalization Deductibles and 20% Doctor Visits that Medicare doesn’t pay. Doesn’t include Prescriptions. Plans F & G start around $150/mth. Hi F with a $2k deductible for what the Insurance Company pays, NOT Medicare starts around $61/month. ANY doctor, provider or hospital that takes Medicare!
It’s practically mandatory coverage, as there is a penalty if you don’t buy it, imposed when you eventually do purchase Rx coverage. Premiums start around $25/month.
Generally very low or no premium, HMO coverage, choose doctors & hospitals from the Insurance Companies authorized list and includes “PD” Prescription Drug coverage.
What to think over?
Medigap coverage usually has a higher monthly premium, Get a Quote but could result in lower out-of-pocket expenses than some Medicare Advantage plans. Medicare Advantage plans, on the other hand, generally cost less and cover more services, which can be the better option for your budget.
Medicare Advantage plans generally limit you to the doctors and facilities within the HMO or PPO, and may or may not cover any out-of-network care. Traditional Medicare and Medigap policies cover you if you go to any doctor or facility that accepts Medicare. If you require particular specialists or hospitals, check whether they are covered by the plan you select.
Medicare Advantage plans often only operate with a certain region – county. If you’re a snowbird living in more than one state throughout the year, traditional Medicare plus Medigap is probably a better choice than an Advantage plan. This may also be true if you travel frequently: Medigap plans provide emergency coverage when traveling outside of the United States to $50k and cover you in all 50 states; Advantage plans generally do not, except for emergencies. Read more: Investopedia
More flexibility with your treatment options
With Original Medicare you don’t have to choose a Primary Care Physician (a requirement of some Medicare Advantage plans), so you don’t have a “gatekeeper” who has the final say on which providers you see. You can shop around for the care and treatment that you want. You can also choose to see any physician who accepts Medicare. On the other hand, MA plans are more restricted in terms of the provider networks they work with. Individuals in rural and isolated areas may have difficulty finding MA plans that work with their local healthcare services.
Additionally, it’s important to remember that if you choose an MA plan initially, and then try to switch to a Medigap policy after a year has gone by, you may not be able to. Signing up for a Medigap policy initially gives you some time to see how your health situation is developing. After a few years with no major medical problems, you may feel more comfortable switching to a Medicare Advantage plan.
Medigap policies can be easier to understand
Perhaps “easy” isn’t the best term, but with Medigap there are 10 types of policies that all pay for the same things–which makes comparing costs relatively simple. These 10 categories are used all over the country, so you can also make decisions about what your costs might be if you move. The same is not true of MA plans, which differ by state and often go by totally different names depending on where you live.
What are some of the disadvantages of choosing
Original Medicare combined with a Medigap policy (versus Medicare Advantage)?
More systems to keep track of
With Original Medicare, a Part D drug plan, and Medigap you have three cards to keep track of and two monthly bills to worry about. For those who feel that they are already burdened by too many monthly bills and pieces of paper, this just adds to the pile.
More decisions to make
Sometimes choices can be a burden. MA plans are supposed to navigate the system for you to contain costs and increase communication. Many people value having a Primary Care Physician (common with many MA plans) to take charge of some of the decisions and find the appropriate specialists.
To get drug coverage, you’ll need to choose a Part D plan
For some beneficiaries, trying to find the right Part D plan is about as fun as a root canal. An MA plan takes care of that for you by including drug coverage already. If you go with an MA plan, remember to make sure that whatever MA plan you choose will cover your existing prescriptions at an affordable price. my medicare matters.org
Medi Gap vs Medicare Advantage from Medicare Rights.org
Five Questions from Medicare.Gov to help you decide on Medicare Advantage or Medi Gap?
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