Turning 65 means that a lot of new opportunities are available to you. One item that most people will need to decide on when their 65th birthday arrives is what to do about Medicare. While everyone who is 65 or older has access to Original Medicare, also known as Medicare Part A and Part B, that doesn’t mean you are fully covered.
In fact, Original Medicare can leave policyholders with unpredictable out-of-pocket costs and a lack of vision or dental coverage. One way to cover these gaps in coverage is by looking into a private Medicare plan. Typically, you will have the choice of going with a Medicare Supplement plan or a Medicare Advantage plan. Both have their positives and negatives but are alternatives that everyone should at least consider.
Let’s explore the Medicare Supplement vs. Medicare Advantage debate and see which one is right for you.
What is the Difference Between Medicare Supplement and Medicare Advantage?
When considering Medicare Advantage or Medicare Supplement, it is important to understand how each interacts with your current Original Medicare coverage. For example, the insurance provider you buy your Medicare Advantage plan from will provide you with health coverage, not Medicare. Conversely, Medicare Supplement is used to cover the out-of-pocket costs left behind by Original Medicare.
To help you determine whether Medicare Supplement or Medicare Advantage is the best option, let’s look at the advantages and disadvantages of each.
What is Medicare Supplement?
Even though Original Medicare provides comprehensive coverage for those over the age of 65, it does leave some gaps that could negatively impact a policyholder. One of the biggest concerns is the out-of-pocket costs that come with receiving care. Purchasing Medicare Supplement insurance can help alleviate the financial burden that comes with outstanding deductibles, copayments, and coinsurance.
Currently, there are 10 different types of policies offered ranging from A through N and includes: A, B, C, D, F, G, K, L, M, and N. Regardless, of which private insurance company you purchase the plan through, the benefits you receive will be the same.
Benefits of Medicare Supplement
When first getting accustomed to Medicare, it can be easy to assume that Original Medicare will be enough to cover you throughout your lifetime. However, this is often not the case. By only having Medicare Part A and Part B, you open yourself up to thousands of dollars in out-of-pocket expenses. Which is why it is important to consider a Medicare Supplement plan.
These plans can help to lower the amount of out-of-pocket expenses that you pay on an annual basis. They also help to give you a little peace of mind that you can afford the care you need as you age. Below are a few other benefits that come with a Medicare Supplement plan:
- Flexible range of plans available to allow for a customized healthcare benefits plan
- No restriction on the network of doctors or healthcare facilities that you can use
- Streamline costs help you plan ahead and prepare for future expenses
- Referrals for a specialist aren’t required
- Coverage can’t be canceled as long as you pay your premiums
Things to Consider with Medicare Supplement
Since the main goal of a Medicare Supplement is to help lower the costs associated with Original Medicare, it does have a couple of drawbacks. For example, you typically won’t get any additional coverages with a standard Medicare Supplement plan. Also, if you are looking to add on Medicare Part D for prescription drug coverage, then Medicare Supplement won’t help with the out-of-pocket expenses.
What is Medicare Advantage?
For people who want an alternative to Original Medicare, there is an option known as Medicare Advantage, Medicare Part C. This plan allows policyholders to retain their current coverage but shift over to a private insurance company where they can also receive additional coverage. Most Medicare Advantage plans will have options available for dental, vision, and hearing care as well.
When signing up for a Medicare Advantage plan it is important to note that you will need to decide between a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) plan. Both utilize medical networks to treat patients, but there is more freedom to choose where you go and who you see with a PPO plan.
Benefits of Medicare Advantage
One of the biggest benefits of Medicare Advantage is that it supplies policyholders with additional coverage items such as dental and vision care. Most Medicare Advantage plans will also extend coverage to Part D which provides prescription drug coverage. Here are a few more benefits to consider:
- Most people will pay a $0 monthly premium
- Access to $0 deductible plan
- Out-of-pocket limits for all plans
- Consistent flat copayments for services
- Access to the SilverSneakers program
Things to Consider with Medicare Advantage
The biggest difference between Medicare Advantage and Medicare Supplement is that Medicare Advantage uses networks. Depending on which type of plan you are in, you may be restricted on what doctors you can see and what medical facilities you can use. With HMO plans, you will appoint a primary care physician who will guide your care and write you referrals to see a specialist.
In a Medicare Advantage PPO plan, you have more freedom to go outside of your network for care at a slightly higher cost. You can also manage your care without a primary care physician, which means you can see a specialist without a referral.
How can The JL Smith Group Help?
Deciding between Medicare Supplement and Medicare Advantage can be difficult, especially if you are brand new to Medicare coverage. That is one of many reasons why we encourage our clients to schedule a free consultation so that they can get all their questions answered. No one should make a decision about their healthcare without knowing all the options available to them.
To schedule your free consultation with one of our trusted advisors, give us a call today at 440-934-9181 or email us at info@jlsmithgroup.com.