Until your clients are faced with actually enrolling in Medicare, they’re probably not entirely clear on the difference between Medicare and Medicare Insurance. It can be confusing, and misunderstandings can carry big consequences.
Medicare is the federal health insurance for people 65 or older and has no out-of- pocket maximum. The risk of this unlimited out- of- pocket cost is why most people chose Medicare insurance, such as a Medicare Supplement or Advantage plan.
Original Medicare (Part A and Part B)
Medicare is a US government program that includes Part A (hospital insurance) and Part B (coverage for doctors and other medical services).
Medicare Supplement Plans (Medigap)
Medicare supplement insurance, also known as Medigap, is issued by private insurance companies to fill in the gaps of Original Medicare. Gaps can include out-of-pocket costs such as deductibles, copays and coinsurance. These plans aim to minimize or eliminate out-of-pocket costs.
Medicare Advantage Plans (Part C)
Medicare Part C—also known as Medicare Advantage—is often mistaken for a government program. But in reality, Part C is also operated by private insurers. These are managed care plans that “bundle” Part A, B and D and benefits are administered by a private insurance company instead of the federal government.
Prescription Drug Plan (Part D)
Prescription coverage is also provided by private insurers, who are contracted with the federal government. Enrolling in a Part D is not mandatory but if you do not have creditable prescription drug coverage for 63 or more days in a row after you are first eligible for Medicare, you may have to pay a late-enrollment penalty if you ever choose to enroll in a Prescription Drug Plan in the future.
Comparing Medicare Supplement Plans and Medicare Advantage Plans
Medicare Supplements Plans
- No network restrictions – You can see any provider or facility that accepts Medicare anywhere in the US. You and your doctor decide the course of your care.
- Outside certain enrollment periods, you can be denied coverage if you don’t meet underwriting requirements.
- Predictable costs.
- Neet to pay a monthly premium.
- This plan can’t be cancelled as long as you pay the premium.
Medicare Advantage Plans
- Need to stay within the plans network. Plan can add or remove providers from its network anytime during the year. Providers can also choose to leave the network any time.
- Most plans require referrals and prior authorizations for some services.
- These are managed care plans. The insurance company dictates the course of care/treatment.
- Nees to pay co-pays, co-insurance and deductibles. Many plans have low or $0 premiums.
- Many plans have extra benefits like hearing, dental and vision.
If you’d like to bring even more value to your clients and learn more about becoming a highly valued referral partner, contact: Lynn Morang, ActivAge Medicare Advisors at 941-567-6000 or lynn.morang@activagemedicare.com