Medigap, Medicare Advantage and Medicare Supplement: What’s what?
If you have ever wondered what the difference is between Medicare Supplement, Original Medicare and Medicare Advantage, you are not alone. Navigating the complicated world of Medicare can seem like a daunting task, but understanding the basics can help you get started.
Original Medicare is coverage managed by the Federal Government and is available to seniors 65 and older. It is also available to people under 65 with certain disabilities or anyone with End-Stage Renal disease (ESRD). It is comprised of Part A (hospital services) and Part B (medical insurance). You can receive healthcare from any doctor or hospital that accepts Medicare, but keep in mind that Part A and Part B may not cover all costs. For example, healthcare while traveling outside of the U.S., most hearing services, dental and vision are usually not covered.
Prescription drugs are also not covered by Part A and Part B. Prescription drug coverage is an optional benefit available through the Medicare Prescription Drug Plan (Part D) or a Medicare Advantage Plan (Part C). However, if you do not elect prescription drug coverage when you are first eligible, you will often pay a late enrollment penalty.
Is There a Difference Between Medigap and Medicare Supplement?
Medicare Supplement and Medigap are different names for the same type of coverage and are used to pay for costs not covered by Medicare Part A and Part B. Private Insurance companies offering these plans must follow federal and state guidelines put in place to protect consumers. (1) Plans are standardized and lettered, meaning that a Medicare Supplement insurance Plan F at one company will cover the same benefits as a Plan F at another company. However, premiums may vary from company to company. Different supplemental plans may also pay different amounts in costs related to your healthcare, such as copays, coinsurance and deductibles. Policies can only be purchased by those already enrolled in Part A and Part B. Those with Medicare Advantage plans are not eligible for a Medicare Supplement plan.
Once you select your Medicare Supplement policy, you will pay premium, which will differ depending on the plan you’ve selected. Policies cover only one person, so spouses and partners will have to enroll in their own policy.
What is Medicare Advantage?
A Medicare Advantage plan, also known as Medicare Part C, often covers the same costs as Original Medicare and Medicare Supplement Insurance, so what is the difference between Medicare Advantage and Medicare Supplement? Instead of enrolling in Part A, Part B and Part D, you can enroll in Medicare Advantage (Part C) through a private insurance company. Medicare Advantage plans are similar to traditional, private health insurance plans and may also cover dental, vision, hearing and other wellness plans. Like private insurance plans, each Medicare Advantage plan has different benefits and restrictions. Some plans may cover a portion of out of network visits while others may require you to stay in network. Just as with any type of private health insurance, it is best to shop around and see which plan will best fit your needs.
Keep Important Dates in Mind
If you find supplemental insurance is the best coverage for you, picking the right time to elect coverage is important. The easiest time to apply for coverage is during the Open Enrollment Period. The Open Enrollment Period lasts for 6 months, beginning the first day of the month in which you turn 65 and are enrolled in Medicare Part B.
In addition to the Initial Enrollment Period, there is an Annual Open Enrollment Period. The Annual Open Enrollment Period is usually when people select coverage or make changes to their existing coverage. The Annual Open Enrollment Period has begun October 15th through December 7th every year since 2011. During the Annual Open Enrollment Period, individuals who switch from a Medicare Advantage plan and re-enroll in Original Medicare have a 63 day guarantee issue period to get a Medicare Supplement plan.
During the Medicare Advantage Open Enrollment Period, you can opt out of your Medicare Advantage plan and return to Original Medicare. You may also switch between Medicare Advantage plans, switch from one Medicare Part D to another, or add Medicare Part D to Original Medicare, provided you are losing Part D coverage due to opting out of Medicare Advantage. Beginning January 2019, this new Medicare Advantage Open Enrollment Period will run each year between January 1st and March 31st. Individuals who do not enroll in Original Medicare when they were first eligible will also have the opportunity to switch from Medicare Advantage to Original Medicare each year between January 1st and March 31st.
Which Plan is Right for Me?
Determining whether to enroll in Original Medicare with Medicare Supplement insurance or a Medicare Advantage plan is a personal decision. Determining which plan is right for you can take some time but the decision should not be rushed. Medicare.gov offers information and tools that allow you to compare plans. Once you understand the basics, you may want to seek help from an agent to compare plans and determine the best plan for you.
Medicare Supplement Insurance:
Neither Bankers Fidelity Life Insurance Company®, its subsidiaries, nor its Medicare Supplement policies are affiliated with or endorsed by the U.S. Government, the federal Medicare program, or the Centers for Medicare and Medicaid Services. This is a solicitation of Medicare Supplement insurance and an independent agent may call on you.
The Medicare Supplement products issued by the Company are insurance policies. Policy form series B 21092 is underwritten by Bankers Fidelity Life Insurance Company®. Policy form series B 21492 is underwritten by Bankers Fidelity Assurance Company™. Limitations and exclusions apply; actual policy provisions control. Rates subject to change on a class basis. Individually underwritten; application to determine eligibility required. Plans are available to all persons eligible for Medicare, including those under age 65 and eligible for Medicare due to disability.
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