Monthly Archives: April 2018

Medicare Advantage vs Medicare Supplements

Feet at a crossroad

Medicare Advantage Plans & Medicare Supplement Plans: What’s the difference?

Given how often we hear this question from clients, we thought it was time to clarify this topic.

First, the most important distinction is to point out that they really can’t be compared as plans, but rather as different paths.

Here’s why. Medicare A and B, or Original Medicare is the coverage you sign up for through Social Security when you turn 65 (for the majority of cases). Everyone signs up for that, and the coverage is fairly standardized: generalized, Part A provides hospital care while Part B covers 80% of a variety of medically necessary services, such as surgeries, doctor visits, screenings, and equipment. (For a complete list, visit here for Part A, and here for Part B).

So the next step is to complete coverage—for the remaining 20% that you must pay for Part B services (there is no out-of-pocket maximum, by the way) and to cover prescription drugs. That’s where the choice between Medicare Advantage plans and Medicare Supplement plans come in.

When considering a Medicare Advantage plan, or a Part C plan, think of the Medicare Advantage (MA) plan company a bit like the trustee of your insurance. You sign up with a government-approved independent company, and they now assume the responsibility of covering you as Original Medicare does. Additionally, you receive coverage for many of the holes in Parts A and B—like an out-of-pocket maximum—at an additional monthly premium. The most common MA plans are Health Maintenance Organization (HMO, as you know them) plans and Preferred Provider Organization (PPO) plans.

If going the way of the Advantage plans is the “trustee” route, think of the Medicare Supplement plans, or Medigap plans, as your insurance “partner” plan route. You keep Original Medicare Parts A and B just as they are under the government’s jurisdiction, but you add on two additional partners—the Medicare Supplement plan to cover the 20% left from Part B and a Part D Prescription Drug plan to cover your prescriptions.

How does the coverage differ?

At a glance, most MA plans are going to have significantly cheaper monthly premiums, and for healthier individuals, that can be an attractive draw. In addition, those plans may include dental, hearing, and vision that would not be available through a Medicare Supplement plan or Original Medicare. But, with that low monthly premium comes higher copays and deductibles than with Medigap plans and often a lot of caveats and restrictions. For example, your policy may leave you with a very narrow list of in-network providers that may not include your doctor or hospital of choice. Another consideration is that MA plans provide prescription drug coverage at their discretion. If you have particular prescription needs that are less common, your policy may not cover it. And, if your MA doesn’t cover your Rx, you cannot purchase an additional Part D plan, as per the regulations. Remember, the Medicare Advantage plan is a closed trust; if some part of coverage is not already included, it can’t be tacked on.

With Medicare Supplement plans route, you have more flexibility to tailor your coverage, but it does usually come with a higher monthly premium than the MA plans. Both paths require a yearly evaluation, but Medigap plans require you to reevaluate two different plans a year (both your Medigap plan and a Part D plan) rather than just one. Since your primary insurance remains under Original Medicare, you don’t have to worry about networks—you can go to any Medicare-participating providers. Just as with the MA plan, your Medigap plan provides out-of-pocket maximum protection when your Medicare-covered expenses run high (like unexpected surgeries or long hospital stays). Medigap plans will not offer dental, vision, and hearing, and your Part D plan needs to be chosen carefully to ensure that all your prescriptions are in fact covered.

So which one is right for me?

As with all things insurance-related, that answer depends on your individual health needs. For very healthy individuals who have very few prescriptions and doctor visits, MA plans may be better because of the lower monthly premiums. Those savings are immediate, and they continue as long as the insured stays healthy and out of the doctor’s office and hospital. Since MA plans have higher copays, frequent appointments and procedures can quickly eat away at what would otherwise your monthly savings. But when only 9% of seniors self-report their health as excellent, Medicare Supplement plans may be the more viable option. Medigap plans usually end up saving you more money on annual basis because of the lower copays.

Both routes require careful consideration, and before you sit down with a licensed insurance agent, it’s important to consider your finances and your healthcare needs. Conduct some research, start perusing plans on your own with Medicare’s Plan Finder tool, and when you meet with an agent, ask every question that is important to you.

Also, directly ask if he or she is an independent agent or if s/he receives benefits from promoting certain plans and paths over others. Don’t settle for an agent who isn’t, because your personal insurance needs should be first and foremost, and not sullied by the enticement of special promotional commissions.

If you have any questions about your Medicare choices, Griffin Insurance Solutions is an independent agency, and we will happily address them and help you find the best plan for you. Contact us today for in-person appointment by email or phone at 919-704-6147 or 800-774-1434.


STEP 1
INITIALIZE YOUR COVERAGE
ENROLL IN ORIGINAL MEDICARE with the government

Part A (Hospital Insurance)

and Part B (Medical Insurance)


STEP 2
COMPLETE YOUR COVERAGE
(We can help you with this step)
OPTION 1
MEDICARE SUPPLEMENT + PART D
OPTION 2
MEDICARE ADVANTAGE PLAN

Covers the “gaps” in services from Original Medicare

Private company assumes the coverage for Parts A & B

Will likely cover
prescription drugs*

Covers prescription drugs

Covers additional services

*You cannot add separate
Part D coverage if your Part C Advantage
Plan does not include Part D.

NEW MEDICARE CARDS | WHAT YOU NEED TO KNOW

new vs old medicara cards 2018

NEW MEDICARE CARDS: WHAT YOU NEED TO KNOW

Medicare is sending you a new card. Starting this month, Medicare has started issuing and mailing out a new type of Medicare card to all enrollees. These new cards comply with a bi-partisan 2015 law that requires Medicare to remove all Social Security Numbers (SSNs) from Medicare cards by Spring of 2019.

First and foremost, we can tell you that the new cards will not affect or change your Medicare coverage at all. But, there a few important points you need to know about them.

How are they different?

Most importantly, the new cards no longer carry the cardholder’s SSN. Instead, you will be issued a unique Medicare Beneficiary Identifier (MBI) that you can find on your new card. The primary goal of the new cards and MBI numbers is to improve security and fight medical identity theft. Doctors and healthcare providers know about this change and will ask for your card and will use new Medicare number. Your MBI will replace your SSN for all Medicare transactions like billing, eligibility status, and claims. And just like with your SSN, only give out your Medicare number to providers that you know and trust.

Second, the new Medicare cards have a new design and are now made of paper, making it easier for medical providers to make photocopies

How do I get my new card?

You will automatically receive it in the mail. Processing takes time, so not all Medicare enrollees will receive their new cards at the same time. You do not need to call to request a new card unless you have a new address or will be moving. To update your address, or to request a replacement card because yours is lost or stolen, visit your mySocial Security account.

What else should I know?

Once you receive your new card, bring it to all new medical appointments, and destroy your old card in a secure way. You will not need the old one any more. Your new card may not come right away, so don’t worry about using it until it arrives.

Destroy only your old Medicare card. If you have a Medicare Advantage Plan ID card (because you have an HMO and PPO), you will continue using that card as your primary Medicare card. However, since medical providers may also ask to see your new Medicare card, bring that to your appointments as well.

If you forget your Medicare card at home when you go to the doctor, don’t worry; they will most likely be able to look up your new MBI.

Anything else?

Be aware of scammers. Social Security and Medicare will not call you for any reason regarding these new cards. If you receive a call asking for your personal information, your credit card, or your SSN, for “processing reasons” or “to receive your new card,” hang up and report it to the Federal Trade Commission.

You can also report it over the phone at 877-FTC-HELP (877-382-4357).

Griffin Insurance Solutions can address any other questions or concerns that you have about your new Medicare cards. Please reach us by email or phone at 919-704-6147 or 800-774-1434