I recently requested info about medicare supplemental plans. Thanks for the replies I received so far. However, I am still wondering if anyone can explain something called medicare advantage plans, and how they work? I have to choose either a medigap plan, or a medicare advantage plan along with medicare a&b. I just need some detailed information about medigap versus the medicare advantage plan. I have a few months before I am eligible but I am trying to do the research now, since it is so complicated. I cannot go to medicare.gov site because I am not 65 yet, and to get the info on that site you have to put in your birth date, etc. Thanks for any information anyone can provide.
If you have 40 quarters into social security, or have a spouse who has 40 quarters into social security you are entitled to part A of Medicare. Part A is your inpatient and hospitalization portion. Part b is your outpatient and diagnostic test portion (doctors, blood tests, etc.). For 2009 the cost for part B is $96.40/month. If you are collecting, or will be collecting social security when you turn 65 then this amount will be deducted directly from social security. If you will not be collecting by the time you turn 65 then Medicare will bill you quarterly.
A medicare supplement fills in the holes and gaps of medicare (deductibles, copays, etc.) that parts a & b don't pay.
Medicare Advantage (also called Medicare Part C) is an alternative to a supplement. Medicare advantage are not supplements.
When you elect to go the route of an MA then you are dis enrolled from Medicare and you are in a Private company policy that must, at a minimum, must give you the same benefits as if you were still under parts a & b of medicare.
There are pros and cons. With supplements you have a premium, with MA you may not have a monthly premium. The 96.40 that comes out of your social security goes to the private company that you have your MA thought instead of to Medicare.
With supplements you don't have a network or referrals or need to name a primary care physician. with an MA you may or may not have to name a primary care physician or may or may not need referrals.
There are also more copays and deductables with an MA. Also, they are usually HMO's but you can get an PPO.
Supplements have a greater number of physicians tht accept them than accept the MA plan. Also, supplements are federal so they are good everywhere. MA's are only good within your local coverage area (generally).
Also, you can get a medicare part D plan as part of your plan where as supplements do not include prescription coverage (unless as an inpatient).
The questions you need to ask yourself are generally: what is my present health condition? any family history of illness or disease run in my family? Is choice of physicians important to me? Do I plan to travel or move?
I have just done all the research for my mother in-law and we decided to go with the medicare advantage plan. The medigap plans were much more expensive. The main thing to look for in the medicare advantage plans is if your doctors take the plans (you need to call them). Also, if you are taking perscription medications - whether they are covered or not. We checked on every perscription before applying to be sure each was covered. Most of the Advantage Plans have a "gap" or "donut hole". This means that you are responsible for paying the full price of the medications once the cost goes over a certain dollar amount (usually $2,510). Some of the new plans (Anthem BCBS) will cover select generics even during the gap - which is a very important thing if you take a lot of meds. Just check on each medication to be sure it is covered during the gap.
Medicare Advantage is the managed care option for your Medicare benefit, rather than the traditional fee-for-service benefit (where you go to any doctor and they bill Medicare directly on your behalf for each service they provide.) Medigap is supplemental insurance over and above your traditional Medicare. Part D is the new drug benefit- you can get that either from a stand-alone drug plan or through a managed care organization. You don't have to be 65 to visit the website, www.medicare.gov, and you can get a lot of info there. I know it seems overwhelming, but if you visit the website and maybe call the local SHIP, you should be able to figure out what you want to do when you are eligible. Good for you for thinking ahead!
Try http://www.medicare.gov again. You don't have to enter any personal info to get answers to general questions. I just tried it again. I clicked on the question "what is medicare advantage?" or something like that. The one where you put in your personal info would still work too. They don't keep the info. It's just for calculations. So you could lie about your birthdate. But you really don't need to. Sometimes it takes a few tries to navigate a large website like that. The next problem is understanding their answers.hehe. I am 68 and still sort of hoping I have made the right choices.
Medigap plans (or Medicare Supplement plans) supplement both Parts A and B. They usually cost on average $100, and now do not include drug coverage. (some of them used to). With supplement plans, you can go to any doctor and don't need referrals or anything like that. The Medicare Advantage plans are a fancy name for the HMOs you see. They usually have very little if any, monthly premium. They can include drug coverage. If you don't mind the HMO, then it's the cheaper way to go. If you prefer freedom, than you'd probably like the Supplement plan better. With the supplement plan, your still going to have to decide on a drug plan.
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