We have all scratched our heads at Medicare options and the difference between Medigap and Medicare Advantage Plans. Also known as Part C, there is quite a distinction between the two. Oh boy – options! Here’s the scoop.
Within the constant communication from the insurance companies offering Medicare Advantage Plans is their sincere desire to educate you and me through this pandemic. And with good cause. Medicare insurance companies need to keep you healthy for as long as they can through their preventive and care for chronic conditions services. After all, we eventually need medications or medical intervention of some sort. That translates into claims for the insurance industry.
The Future of Medicare Advantage
Recent statistics show that Medicare Advantage Plans (MAs) are a popular alternative to Medigap and original Medicare. According to Better Medicare Alliance, there are 4,700,675 Medicare eligibles in Florida. 50.83% are in Medicare Advantage Plans, and of those, 20.56% are in Special Needs Plans. Only 8.54% of all Florida eligible beneficiaries are on employer-sponsored plans. Take a look at a few popular counties:
Medicare Part C Coverage
As a reminder, original Medicare – Parts A and B – covers hospitals, doctors, and medical procedures. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. It does not cover prescription medication.
Medicare Part C plans must include original Medicare (Parts A and B) and strengthen the plan with extra benefits like dental, vision, hearing, OTC, transportation to the doctor, and gym memberships. Medicare Advantage Plans are offered with and without Part D drug benefits. These benefits are purchased separately when you have a Medigap policy.
Specific Plan Types
Medicare Advantage Plans resemble an employer plan or Marketplace plan in that they cover Parts A, B, and D, offer HMO and PPO options and include the additional perks of Part C.
HMO (Health Maintenance Organization)
HMO plans are cost-effective where the primary care physician (PCP) acts as a gatekeeper and has eyes on your overall health. You will need referrals by that PCP to see a specialist. Attractively, copays are usually lower overall on these plans.
PPO (Preferred Provider Organization)
PPO plans are the most popular due to having a greater level of freedom to select providers. They don’t need a referral to see a specialist; coverage is available whether their doctor is in the network or out of state. However, copays and deductibles are higher when using out-of-network providers.
Special Needs Plans (SNPs)
Medicare Beneficiaries that have chronic illnesses like diabetes, heart disease, to name a few, have the added benefit of these plans. These Plans specifically address the medical care and medications needed to support chronic conditions. Likewise, dual eligibles, beneficiaries that qualify for the Medicare Savings Program, are part of the Special Needs category and offer no to low copays with many added benefits to address their needs. Newly designed perks may consist of healthy food cards and expanded dental, covering dentures.
A system is in place by The Centers for Medicare & Medicaid Services (CMS) to measure the quality of care throughout these plans. A Five-Star Rating System measures how well the insurance company and the health plan manage chronic conditions, the availability of doctor appointments, drug pricing, and the member’s experience. Star Ratings are updated every year.
As you can see, Medicare Advantage Plans are growing in popularity and offers quality, affordable, and enhanced coverage. Many of these plans have $0 monthly costs making them an attractive alternative to the higher monthly costs of Medigap. It is essential to make sure your doctors are within the network. There are 85-118 plans in any given Florida county; 119 in St. Petersburg alone. Finding the right fit for your medical needs will make all the difference in your care for the year. Contacting a Medicare broker gives you a broad perspective on the many insurance companies and their various plans and perks. That’s where I come in. Bayside Medicare brings decades of health insurance expertise and is poised to evaluate your individual needs to help you select the plan that’s right for you. Schedule an appointment today!
Wishing you well.
*As a note, many clients ask about the difference between Medicare Advantage and Medigap policies. For an overview of Medigap, read my June 2021 Medigap blog or reach out to further discuss your options.
About Dayna Schafer
Dayna is a Certified Medicare Insurance Planner™ and a member of the Rise Community. Her agency, located in St. Petersburg, FL, where she has helped thousands of individuals and Medicare beneficiaries understand their benefits by ‘Making it Make Sense.’ To relentlessly seek out the right fit for her client’s healthcare needs, Dayna certifies with triple the average amount of insurers.