Toni:
I have been receiving different insurance companies marketing material and I am confused about the difference between a Medicare Supplement and a Medicare Advantage Plan. They all seem to be the same. How are we supposed to understand all of this? Please explain. Susan M from Missouri City
Hello Susan:
On pages 66-81 of the 2012 Medicare & You handbook explains what are a Medicare Supplement and a Medicare Advantage plan. The handbook does not compare the differences with the plans. Some of the differences between a Medicare Supplement and a Medicare Advantage Plan are:
- A Medicare Supplement works directly with “Original Medicare”.
- With a Medicare Supplement you chose which doctor, hospital, home health agency, skilled nursing facility, etc that accepts Medicare assignment.
- The downside to a Medicare Supplement is that you have a monthly premium that can increase every year.
- You may enroll and will pay separately for a “Stand alone” Medicare (Part D) Prescription drug plan.
- When you choose a Medicare Advantage Plan, then Medicare pays the insurance company a certain amount every month for your care as long as you are on the plan.
- When you go to the doctor or visit your pharmacist, you have to use your Medicare Advantage card, not your Medicare card.
- A Medicare Advantage Plan must provide all of your Part A and Part B benefits and some Medicare Advantage Plans have Part D prescription drug plans included.
- A Medicare Advantage Plan may have a zero to low dollar premiums.
- With a Medicare Advantage plan, you may have different co pays, co-insurances or deductibles to pay and have maximum out of pocket expenses to meet.
- Medicare Advantage Plans may offer extra benefits such as gym memberships, dental benefits, transportation and other additional benefits.
- Many healthcare facilities, such as MD Anderson accept very few Medicare Advantage plans. Call facility and make sure they accept which Medicare Advantage plan you want to enroll in.
**It is best to talk with your Doctor, when you are trying to make a decision about which way to go: Medicare with a Medicare Supplement and a standalone Part D Medicare prescription drug plan or Medicare Advantage plan. Always take your time when trying to decide.**
Dear Toni:
I turn 65 in January, 2013 and am currently working. Our company health plan is a HSA with a $5,000 deductible. I’ve been told that I need to enroll in a Part D prescription drug plan because this health plan is not creditable coverage. What does that mean?
Thanks, Jeff from West University area
Hello Jeff:
That is correct, Jeff!! If your group prescription drug plan is not as good as Medicare’s standard prescription drug plan, which means has a $321deductible or more for 2012. Or if your company and/or your insurance company states that the plan is not creditable, then you should enroll in a Part D plan to keep from having a 1% per month penalty which goes back to the month your Part A started, when you do enroll in a prescription drug plan. Read page 90 of the 2012 Medicare & You handbook about the Part D late enrollment penalty. Call 1/800-MEDICARE, find out which plan is right for you and enroll in that plan.
Next week, I will discuss the problem Tom from Cypress is having with his late enrollment in Part D….so stay tuned for more information.
For those “Confused about Medicare” join me for my first pre-Open Enrollment workshop on Thursday, October 4, 2012 at 6:30 PM at the Champion Forest Baptist Church located at 15555 Stuebner Airline, Houston, Tx 77069. RSVP: 832/800-4674…Everyone welcome. Come and get your questions answered about Medicare and how Healthcare Reform is affecting Medicare!
Toni King is advocate/consultant for those “Confused about Medicare” send Toni an email at toni@tonisays.com or call 832/519-TONI (8664). Visit Toni’s new website www.tonisays.com.
