Is a Medicare Advantage plan right for you?
No one type of Medicare Insurance plans fits everybody the same. What may work best for one person, may not work very well for another person. There isn’t really any right or wrong answer on the type of plan you choose. It is a personal choice for you to decide what you feel fits your needs the best. It is important to get all the facts first before making an educated decision. It is also important to pick the correct plan that fits your needs, since not all Medicare Advantage plans have the same benefits and Medicare Supplement premiums may be too costly for some people. Medicare Supplements don’t include many benefits that most Medicare Advantage plans include such as: dental, vision, and hearing benefits.
I would first recommend figuring out what type of Medicare Advantage plan would fit your needs the best (an HMO or PPO plan) OR if a Medicare Supplement (different type plan altogether) might possibly fit your specific needs better.
HMO plans are the least expensive of the above choices. However, they are also the most restrictive. HMO plans have a network of doctors/hospitals that you are required to use, if you want to be covered by the HMO plan. If you go out of network, with most HMO’s you will NOT be covered! (UNLESS it is true emergency. Any Medicare insurance plan allows a member to go out of network, if it is a true emergency, and member would still pay in-network rates.) Also with most HMO’s you need to get a referral from your primary care doctor to go to a specialist. Many HMO’s do not allow you to go out of the local service area or you would be considered out of network and not covered unless a true emergency.
PPO plans are kind of in between an HMO and a Medicare Supplement.
PPO plans give you more flexibility than an HMO, but less flexibility than a Medicare Supplement. You still would have a network of doctors/hospitals that you want to use to keep your out of pocket costs down. However, you can go out of network, but it will cost you more. Also with PPO plans, you don’t need to have a referral to see a specialist!
Most, but not all, Medicare advantage plans include prescription drugs in their plans. In addition, many Medicare Advantage plans include dental, vision, hearing, fitness club memberships, Over The Counter (OTC) credits, and other additional benefits.
Medicare Advantage plans have copays and coinsurance. Some plans may also have deductibles. So it is important to review the Summary of Benefits of each plan before picking a specific plan.
A Medicare Supplement is totally different type of plan than the Medicare Advantage plans. Medicare Supplement plans have different letter plans to compare each type plan before you enroll. A Plan G is the top of the line for people just turning 65. With a Medicare Supplement, you can use any doctor or hospital in the United States that accepts Medicare. There isn’t a network of doctors you need to go to in order to be covered. Also with a Plan G, for example, you would pay a quite a bit more expensive monthly premium than a Medicare Advantage plan.
Although, with a Medicare Supplement Plan G, you would only have to pay the Part B deductible ($240/year for 2024) and then you would be 100% covered for Medicare “Medical" expenses for the rest of the year. Keep in mind that Medicare Supplements do NOT include Part D prescription drugs. So you would need to to enroll and pay an additional monthly premium for a stand alone Prescription Drug Plan, in order to have Part D prescription drugs covered. Most of those stand alone Prescription Drug Plans have a high deductible for the more expensive brand name drugs and even for some generic drugs. Plus you may still have copays for each of your drugs, unless they are inexpensive generics.
Note: Medicare Supplements do NOT cover dental, vision, hearing, nor many other benefits that a Medicare Advantage may include at no extra charge.
Lastly, regardless whether you pick a Medicare Supplement plan or a Medicare Advantage plan you are required to be enrolled in both Part A and Part B first. Part A is usually free for most people that worked in the United States and paid taxes for a certain period of time. Part B for most people (in 2024) has a premium of $174.70/month. (Note: People with higher incomes may be charged more by the government.)
Related blog I wrote a while back:
Medicare Advantage Plans - Pros and Cons
https://mgildarinsurance.com/blog/medicare/medicare-advantage-plans--.html
Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.
As I mentioned above, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.
By calling this number, I understand I will be directed to a licensed insurance sales agent.