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Medicare Supplement or Medicare Advantage Which Way Do I Go!!

by | Sep 27, 2013 | Medicare Advantage Plans, Toni Says

Reader Alert: 2 weeks to October 15th…

Medicare’s open enrollment begins…

Dear Toni:

What, if any, is the difference between “advantage” and “supplement”? And can you explain how Obamacare is affecting these plans. Thanks, Joseph

Well Joseph:

Choosing between a Medicare supplement and a Medicare Advantage plan can be trying for some. Some go to the doctor a few times a year and some visit the doctor more.  Medicare is no cookie cutter…one size does not fit all!!

Medicare releases all new Medicare Advantage and Part D plans for 2014 on Tuesday, Oct.1, 2013; I cannot tell you right now how Obamacare is affecting Medicare.  But soon I will know and let my readers know.

First, talk with your doctor or specialist about which option to pick: 1) Medicare with a Medicare Supplement and a standalone Part D Medicare prescription drug plan or 2) Medicare Advantage plan with a Part D Medicare prescription drug plan.

Let’s discuss the difference in the two types of Medicare options.  On pages 55-81 in the 2013 Medicare & You handbook explains what is a Medicare Supplement or a Medicare Advantage plan.  The handbook does not compare the differences with the plans.

Below are some of the differences of the two plans:

1) Medicare Supplement:

  1. A Medicare Supplement works directly with “Original Medicare”. Medicare will pay its share of the Medicare-approved amount for “medically necessary” (new Obamacare buzz words) covered healthcare costs. Then, your Medicare supplement will pay its share.
  2. With a Medicare Supplement you chose which doctor, hospital, home health agency, skilled nursing facility, etc. which accepts Medicare assignment for your healthcare.  You and your healthcare provider are in control of your healthcare.
  3.  The downside to a Medicare Supplement is that you have a monthly premium that may increase the premium rate each year.
  4. You may enroll and will pay separately for a “Stand alone” Medicare (Part D) Prescription drug plan.

2)  Medicare Advantage Plan: 

  1. To qualify for the plan:  a) You must be enrolled in both Medicare Parts A & B.  b)Live in the service area 6 months out of a year…c)Not have end stage renal disease (kidney dialysis)
  2. 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. Your Part B must always be in effect.
  3. When you go to the doctor or visit your pharmacist, you must only use your Medicare Advantage insurance card, not your Medicare (red, white and blue) card.
  4. 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. Also has “extra” benefits such as gym membership, etc.
  5. A Medicare Advantage Plan may have a zero to low dollar premiums.
  6. 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. Most Medicare Advantage plans have preventative/wellness benefits.  Insurance companies have learned that if you stay well, you do not use the insurance as much.
  7. Healthcare facilities, like MD Anderson accept few Medicare Advantage plans.  Talk to your provider or facility and make sure they accept the Medicare Advantage plan you want to enroll in. Find out if the Medicare Advantage plans, you are researching are an in network or an out of network provider. (This is very important)

Confused about Medicare” Workshops the week of Sept 28-Oct 4th

  1. Tuesday Oct 1st from 6:00pm to 8:00pm at the West University Place-Senior Center, West University Place, TX  77005.
  2. Thursday, October 3rd from 6:00pm-8:00pm at Champion ForestBaptist Church-Multipurpose Building, 15555 Stuebner-Airline Dr, Houston, TX 77069. These workshops are free and the public is invited.  RSVP as seating is limited RSVP 832/800-4674. Visit https://tonisays.com/calendar-of-events/ to view which workshop is in your area.

Toni King, Medicare advocate, consultant and author of Medicare Survival Guide, available only at www.tonisays.com.

Sign up for the new Medicare Survival Newsletter, available at www.tonisays.com.  For any Medicare questions, contact Toni at www.Tonisays.com/ask-toni.

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