Medi Gap, Original Medicare & Part C Medicare Advantage
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.
Also confusing is the difference in pricing – premiums and subsidies between under 65 plans ACA/Obmacare and Medicare. So, depending on your income, some have much lower premiums with Medicare and other’s may pay more as they no longer have big subsidies under ACA Affordable Care Act.
Three main options:
Medi-Gap – Supplemental
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!
- Anthem Blue Cross
- United Health Care
- Blue Shield – Medi-Gap – Any Medicare Provider
Rx Prescription Drugs PDP
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.
- Blue Cross Rx
- Blue Shield Rx
- Donut Hole – Coverage Gap
- Shop & Compare Tools Part D Rx
- Part D Rx Low Income Subsidy – LIS – Extra Help
- Shop & Compare Tools Part D Rx
- UHC – Part D Rx
Medicare Advantage – MAPD
Generally very low or no premium, HMO coverage, choose doctors & hospitals from the Insurance Companies authorized list and includes “PD” Prescription Drug coverage. One must still obtain Part A Hospital and Part B $170 Premium from the FEDERAL Government Medicare.Gov before they can enroll in a Medicare Advantage plan.
- Anthem MediBlue Plus
- Blue Shield 65 Plus – Inspire HMO 2021
- United Health Care
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
Medicare #Choices – from Medicare & You 10050
- Medicare Choices VIDEO Medicare.Gov
- Part A is Hospital Coverage and normally US Citizens who have worked here don’t have to pay any premium. There are deductibles and limits if you are in the hospital a long time.
- Part B is out of hospital – doctor visits the premium starts at $135/month, more if you make a lot of $$$ Part B leaves 20% for you to pay and doesn’t cover outside the USA.
- Part C is Medicare Advantage – generally an HMO… that would cover the gaps in Parts A & B, Medicare pays the Insurance Company to transfer the risk Learn More and do the administration, it also includes Part D Rx
- Part D Rx Prescriptions Covers your prescriptions. If you get a Medicare Advantage Plan – HMO then it’s included. Otherwise it runs $30 to $100/month
- Medi Gap or Supplemental covers the gaps in Parts A & B. Part D is a separate coverage. Medi Gap allows you to go to ANY MD that accepts Medicare! https://www.medicare.gov/physiciancompare/
- Medicare Decision Guide – Blue Shield pdf
- Medicare does not cover Long Term Care (Skilled Nursing is very limited) or Life Insurance
That's why the premium is very low or ZERO!
- Set a phone or Skype Meeting
- We can now do SOC Scope of Appointment, before the Meeting via a 3 minute recorded meeting 2 days before. AHIP Training Module 4 Page 14 *
- #Intake Form - We can better prepare for the meeting
- Medicare Advantage (Medicare Part C): An Overview – 11-15-23 Hi Cap
- HMO - Narrow Networks?
- HI Cap CA Health Care Advocates Fact Sheet
- Do I just sign up with a Medicare Advantage Company and automatically get * Parts A & B or do I have to get those from Medicare.Gov * VIDEO
- Get Quotes, Full Information and Enroll
- MANDATED wording!: Think Advisor * ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
- FYI a 4.27.2022 HHS Office of the Inspector General report found that MAPD plans denied 13% of prior authorizations that would have been covered under original Medicare (Conversely, Medi Gap, just follows what Medicare pays.)
- 88% of MAPD enrollees are happy
MAPD plans often include Dental & Part D - Rx Prescriptions and often have NO premiums! How is that possible? The Federal Government pays them around $700/month to handle your medical care. You must continue to pay your Medicare Part B premium of about $170/month. It's best to apply when you turn 65 for the supplement plans or advantage plans, as that's the main "Open Enrollment" period, guaranteed issue for any plan.
Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?
- If You Have Problems with Your Medicare Advantage Plan – 11-22-22
- C-003-When Medicare Advantage Plans Terminate Coverage– 01-19-21
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.
People enrolled in Medicare Advantage plans are switching to Medicare fee-for-service at an alarming rate during their last year of life, according to a Government Accountability Office (GAO) report modern health care.com/dying-ma-customers-are-switching-traditional-medicare
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
Five Questions from Medicare.Gov to help you decide on Medicare Advantage or Medi Gap?
Click on graphic to enlarge
View in Medicare & You
- Individual & Family Health & Dental Direct ***
- Medi Gap, Part D Rx & Medicare Advantage 2024
- Employer Small Group
- No extra charge for Broker Support
- Steve Video @ Blue Shield of CA Headquarters
Our video explaining the Governments brochure on choosing a Medi Gap Policy. Click the little square on the right, to enlarge the video.
- 2023 Official Medicare Guide to choosing a Medi Gap Policy # 02110
- Anthem Blue Cross Information & Enrollment
- United Health Care
- Blue Shield – Medi-Gap Information & Enrollment
- Health Net
Medi Gap pays the medical expenses that Original Medicare Part A (Hospital) and Part B (Doctor) doesn't. Check out the chart on this page to see what Medicare Pays, what you pay and what a Medi Gap plan pays.
- If you have a Medigap policy and get care, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then, your Medi-gap policy will pay its share. You’re responsible for any costs that are left. Medicare.Gov *
Original Medicare, Medicare Advantage nor Medi Gap pay for long term care either in a nursing home or at home care. Get more information on Long Term Care here. Even if you think you can't afford any extra premiums, there's a lot of valuable information to help with planning.
Wrongfully denying claims that should have been covered under Medicare
Bibliography – Medi gap vs MAPD
Links & Resources
- medicare rights.org
- consumer reports.org
- my medicare matters.org
- A look at profitability in Medicare Advantage
- The state of Medicare Advantage in 2022
- OPINION How Medicare Advantage Scams Seniors | Opinion Newsweek
- What seniors never see or hear in the ads is that unlike traditional Medicare, most Medicare Advantage plans require doctors and hospitals to get approval in advance in many cases before treating their patients—or even prescribing certain medications. The process to get an MRI approved for a frozen shoulder or knee arthritis can take weeks, if not months. Such “prior authorization” requirements are exceedingly rare in traditional Medicare.
- one in four Medicare Advantage plans are being falsely advertised. Read More – Just Care USA.org *
- Medicare – Introduction – Part A Hospital – B Outpatient – D Rx Medi Gap & MAPD
- Coverage in Part A Hospital & B Doctor Visits? Part D Rx
- Enroll ONLINE for Medicare Part A Hospital & B Doctor Visits
- Medi Gap – Supplement Plans – non conical
- Medicare Advantage Plans – Part C
- Anthem MediBlue Plus
- United Health Care
- Blue Shield 65 Plus – Inspire HMO 2022
- Enrollment Dates for MAPD – Medicare Advantage & Part D Rx
- Original Medicare & Medi-Gap – Supplement vs Medicare Advantage MAPD
- SNP Special Needs Plans
- Part D Rx Prescriptions no index
#Medicare10050 and You 2024
Everything you want to know
- Steve's Video Seminar Introduction to Medicare & You
- Audio from Medicare.Gov
- Clear View to Medicare Patient Advocate.org - 36 pages
- Your Medicare #Benefits # 10116
- Don't like computers? Prefer a printed version be mailed to you? Audio MP 3
- Inpatient ONLY - How Medicare Pays for your Surgery Part A vs Part B Very Well Health.com
- What's Covered App for Smartphones
- Medicare Coverage Database Search
- MLN Items & Services Not Covered Under Medicare
- An Overview-05-19-23 CA Health Care Advocates Hi Cap
- Original Medicare: An Overview CA Health Care Advocates Hi Cap
- 2024 Premiums, Coinsurance & Deductibles – 10-19-23 CA Health Care Advocates Hi Cap
- Supplementing Medicare: An Overview 10-30-20 CA Health Care Advocates Hi Cap
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- Use our scheduler to Set a phone, Skype or Face to Face meeting
- #Intake Form - We can better prepare for the meeting (National Contracting Center)
- TITLE XVIII—HEALTH INSURANCE FOR THE AGED - Medicare AND DISABLE
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