Every year, seven out of ten seniors in the United States choose Original Medicare plus a Medicare Supplement 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 (the annual Medicare Part B deductible) with the most comprehensive 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.
Consider this, if you were to get cancer would you want the flexibility of seeing specialist at a facility like MD Anderson cancer center? Or would you rather be limited to whatever doctor happens to be in your local network? What about other critical or chronic conditions? When your life is on the line, do you want the flexibility of seeing any specialist in the country of your choosing, or just whomever happens to be in your network? When you have Original Medicare you have that flexibility. When you add a supplement Medigap policy, you have that flexibility plus very limited financial exposure to the medical bills. In some cases, your financial obligations will be less than $200 regardless of the medical cost.
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 in network and $10,000 out-of-network. That $6,700 maximum financial risk assumes that they stay only within 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 usually with a maximum $10,000 annual out-of-pocket risk. It’s 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 is not obligated to cover the expense, leaving the insured with the bill or unable to obtain medical treatment they need. With Original Medicare, you and your doctor decide your care.
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.
*If you live in either Minnesota, Massachusetts or Wisconsin, your state has laws that give you choices other than the standard Medicare Supplement plans. You can still get Original Medicare, but check you state and Medicare for details on what Supplement coverage is available to you. Please check with your state insurance commissioner’s office for more information.
In the Medicare & You handbook, Medicare beneficiaries are informed that insurance companies can only offer “standardized” policies. All policies offer the exact same benefits. 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. 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 Medicare 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 exact same Medigap Plan. Consumers owe it to themselves to shop the price of the plan.
This is where we or other independent insurance brokers come in. The independent insurance broker’s role is to educate the client on their choices and help them select the plan that best suits their needs and their budget. The agent should offer all Medicare Supplement plans from all major insurance carriers. If the agent only offers plans from one or two insurance companies, they are too limited to represent your best interest.
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 Part B you may have to go through an underwriting process. An experienced insurance broker will have knowledge of the health questions that are asked and the underwriting policies of all the different insurance companies. This 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.
In Florida, Medicare Supplement prices are much higher than those found in the rest of the country. For Florida residents we suggest considering Medigap Plan F High-Deductible. It will keep your out-of-pocket risk down to $2,181 (as of 2015) and give you the same 100% coverage of a Medicare Supplement Plan F. Our article