Every year, seven out of ten seniors in the United States choose Original Medicare plus a Medicare Supplement plan over Medicare Advantage plans. The reasons are clear, the benefits of Original Medicare plus a Medigap Plan (another term for a Medicare Supplement) are far superior to any Medicare Advantage choice. Original Medicare offers you freedom to choose from any doctor that takes Medicare insurance. It also limits your financial risk with maximum out-of-pocket exposure from zero dollars to just $147 with most plans. Also, your care is defined by you and your doctor, not an insurance company.
Theoretically, Medicare Advantage plans are supposed to offer at least the same benefit as Original Medicare Part A & B. However, very few seniors with Medicare Parts A & B do not add a Medigap Plan to supplement Medicare. Medigap Plans are inexpensive and assure the Medicare beneficiary of very limited financial risk, while allowing the flexibility see any specialist at any facility in the country. With 99% of all doctors taking Medicare insurance, finding the best doctor is easy.
Seniors that choose the Medicare Advantage route cannot add a Medicare Supplement to their insurance coverage. It’s not allowed, by law. So, while they may have coverage that is roughly equivalent to Medicare Parts A & B, they will typically have a maximum out-of-pocket annual risk of up to $6,700. That maximum financial risk assumes that they stay in the designated network of doctors and do not seek specialists or other help outside the network. If a patient wishes to seek medical expertise outside their network it is typically at their own cost without limit. It is also important to consider that with a Medicare Advantage plan you have given up your Medicare rights to the insurance company. There are many documented cases where the insurance company has disallowed medical coverage by defining the medical procedure as “Not medically necessary”. By designating a procedure as not medically necessary, the insurance company does not have to cover the expense, leaving the insured with the bill or unable to obtain medical treatment they need.
There are currently eleven different Medigap Plans available to most consumers. The plans are identified / named by letter. Plan A, B, C, D. F, F-HD, G, K, L, M,N. While that may seems like a lot of choices, the benefits of each plan are laid out in table format in both the Medicare & You handbook as well as the government publication Choosing A Medigap Plan. Of the available Medigap Plans, Plan F, Plan G and Plan N are the most popular.
When shopping for a Medigap Plan, it’s best to first review the different plans available and their costs. While the benefits of each plan type are standardized, their prices are not. This means that the benefits of a Plan G, for example, are exactly the same no matter which insurance company offers the plan. The plan benefits are designed by the government authorities and the insurance companies simply administer the benefits.
In the Medicare & You handbook, Medicare beneficiaries are informed that insurance companies can only offer “standardized” policies. All policies offer the exact same benefits. However, an insurance company does not have to offer ALL the plans. They can pick and choose which Medigap Plan (s) they wish to offer. The handbook also warns that different insurance companies can charge different prices for the exact same plan. That is why consumers should first identify which plan they want and then shop for price. Since all the plans of the same letter are identical, the only difference is the price. Many people are surprised by this fact when they see that some companies charge $100s per year more than others for the same Medigap Plan.
This is where we come in. Our role as an independent broker is to educate the client on their choices and help them select the plan that best suits their needs and their budget. Different states have rules that can impact your plan choice. Medigap Plans are priced by zip code, age, gender, smoking habit (if any) and general health. While you can get a new Medigap Plan or switch plans at any time, if you are not new to Medicare you may have to go through an underwriting process. Our knowledge of what health questions are asked and the underwriting policies of all the different insurance companies can help you get the plan you want at the best price possible. If you are new to Medicare Part B, there is a six month window where you can get a new Medigap Plan without the insurance company asking any health questions.
After a brief interview, we can advise on the best plans available and which company will offer that plan at the best price. There are also household discounts from 5% to 12% depending on the state. Because we offer all Medigap Plans from all major insurers, we are happy to show all the prices and plans available. Our process is transparent and the client is left confident they have the best plan at the best possible price.
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