Commonly Overlooked Medicare Facts
Medicare
• Medicare does not have a maximum annual cost for beneficiaries portion of the medical expenses. People with certain conditions and needs can find themselves owing substantial sums for their portion of Medicare deductibles, copayments and coinsurnace.
• Medicare does not come with prescription drug coverage. Medicare Prescription Drug coverage is available thru private (insurance) companies and can reduce the out of pocket expense a Medicare beneficiary experiences by a substantial amount.
Medicare Advantage Plans
• Medicare Advantage Plans protect the enrollee from unlimited Medical expenses
• Medicare Advantage plans have service areas where the plans are available. Some service areas may be available state wide and others in only specified counties. Enrollees may choose from the plans available where they live.
• If you travel within the USA, short trips are no problem as all options allow for Emergency medical and urgent care. But if you live two or more places for extended periods, an HMO or a PPO network plan may effect your medical options.
• A single trip to the ER on original Medicare has a cost share equal to that years Part B deductible. Medicare Advantage Plans help limit this cost.
Medicare Advantage Plans aka Medicare Health Plans or part C are contracted with Medicare to provide all Medicare services and supplies to their enrollees. There are terms and conditions associated with these plans that help manage the care and cost associated with that care including prior authorization for some services. These plans often add extra benefits.
*I help people enroll in 10 states with multiple service areas in each state. Click Here 2024 to connect to my multirater system that shows each of the organizations and the Medicare Advantage Plans I represent in the various service areas of those states. Enter your Zip code and county to see what I offer in that service area.
Medicare Supplement Insurance
• Medicare Supplement Insurance policies cover all or almost all of copays, coinsurance and deductibles of original Medicare. That means your premium for the policy is the majority of what you would pay annually. Its a practical maximum and it's a minimum. Even if you don't use any Medicare services, the premium on a Medicare Supplement Insurance Policy is still due. For some people, being able to budget for medical costs is more important than saving money.
• Medicare Supplement Insurance doesn't have networks of providers. Providers are required to be contracted with Medicare but Medicare enrollees are not required to get referrals or to use providers in specific networks. Enrollees in Medicare can choose to see providers across the USA.
• Some providers will not accept patients with original Medicare but they will take specific Medicare Advantage plans and visa versa.
• Medicare Supplement Insurance does not generally expand Medicare Benefits but it does pay some or all of the portion Medicare does not cover. No networks to deal with and less managed care plus you can budget to the premium. For people with high medical utilization, a Medigap aka Medicare Supplement Policy can be easier and less expensive. The premium covers much of your cost so your financial risk is limited.