When you are ready to sign up for Medicare supplemental insurance, consider these 7 things as outlined by Medicare. Our agents at Independent Benefit Advisors are here to help you navigate what you need and the differences between each type of policy.
Call us at 888-303-9690 for assistance.
COSTS:
How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
Costs in Original Medicare
There’s no limit on how much you pay out-of-pocket per year unless you have supplemental coverage.
Costs in Medicare Advantage
Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year. This option may be more cost effective for you.
COVERAGE:
How well does the plan cover the services you need?
Coverage in Original Medicare
Medicare covers medical services and supplies in hospitals, doctors’ offices, and other health care settings. Services are either covered under Medicare Part A or Part B.
Coverage in Medicare Advantage
Plans must cover all of the services that Original Medicare covers. Some plans offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental. You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.
Your other coverage
If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.
SUPPLEMENTAL COVERAGE:
Supplemental coverage in Original Medicare
You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your deductible and coinsurance instead of choosing a Medicare Advantage Plan.
Supplemental coverage in Medicare Advantage
It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). And, many Medicare Advantage plans offer vision, hearing, and dental. You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.
PRESCRIPTION DRUGS:
Do you need to join a Medicare Prescription Drug Plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What’s the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan’s formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?
Prescription drug coverage in Original Medicare
You’ll need to join a Medicare Prescription Drug Plan (Part D) to get drug coverage.
Prescription drug coverage in Medicare Advantage
Most Medicare Advantage Plans include drug coverage. If yours doesn’t, you may be able to join a separate Part D plan.
DOCTOR & HOSPITAL CHOICE:
Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
Doctor and hospital choice in Original Medicare
You can go to any doctor that accepts Medicare.
Doctor and hospital choice in Medicare Advantage
You may need to use health care providers who participate in the plan’s network. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of-network coverage.
QUALITY OF CARE:
Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services?
TRAVEL:
Travel coverage in Original Medicare
Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers travel coverage.
Travel coverage in Medicare Advantage
Plans usually don’t cover care you get outside of the U.S.
When you are eligible for Medicare, give us a call and let us help you navigate the Medicare and help you make the best choice for your lifestyle! Contact us for any questions that you have about Medicare – we are here to help you! There is never a cost to you for using an insurance broker. Call us at 888-303-9690
Contact The Independent Benefit Advisors for Medicare in North Carolina
Give us a call at 919-303-9690 so that we can help you navigate the Medicare roadmap and get the right plan for you!