When a client is first eligible for Medicare, one of the first things we do is inform and educate on what Medicare covers and what is doesn’t.
Medicare consists of Part A and Part B services. Part A covers inpatient hospital care, skilled nursing care, hospice care, and home health care. Part B covers doctor visits, ambulance services, lab services, preventative services, and durable medical equipment.
Normally, Medicare will cover aproximately 80% of your bills. The remaining 20% is what clients are concerned about and why they reach out to us. They reach out to us to help them go over their options on both Medicare Supplemental Plans and Medicare Advantage plans. Both Medicare Supplemental and Medicare Advantage plans are offered by private insurance companies.
Whether you decide to go with a Medicare Supplemental Plan or a Medicare Advantage plan, you will still have to pay for your Part B premium. One of the differences is that with a Medicare Supplemental Plan, the plan pays after Medicare pays. In other words, it works in addition to Medicare. With a Medicare Advantage plan, the Medicare Advantage plan works instead of Medicare. The insurance company that has the Medicare Advantage plan pays for your health care costs minus any deductibles, co-pays, or co-insurance.
Once a client knows what Medicare covers, we then go on to show you Medicare Supplemental Plans. We show you the Medicare Supplemental plans that are available in your state and then share with you what you can expect for out of pocket expenses. Some of those out of pocket expenses could be a Part B deductible and/or co-pays when you see a physician.
We share the pros of a Medicare Supplemental Plan. Those pros include no network of physicians or hospitals. This means that any doctor that accepts Medicare will take your Medicare Supplemental Plan. You also never need a referral to see a specialist. If you want to see a specialist and that specialist takes Medicare, your Medicare Supplemental Plan will cover your health care costs minus any deductible or co-payments. Medicare Supplemental Plans also have some coverage for foreign travel.
The con to a Medicare Supplemental Plan could be cost. The plans are more expensive than a Medicare Advantage plan for the premium, however, your out of pocket expenses are much lower. With a Medicare Supplemental Plan, there is no prescription drug coverage. This means that if you want prescription drug coverage, you would need a separate prescription drug plan to help you pay for your prescriptions. Medicare Supplemental plans also have no dental, no vision, or no hearing benefits. If this is a benefit you wanted, you would need to purchase yet another plan to help cover those expenses.
With a Medicare Advantage Plan, one of the pros is the cost. Some Medicare Advantage plans have a $0 premium and typically range under $100.00 a month. Medicare Advantage plans can have extra benefits such as dental and vision. They also can include prescription drug coverage so you wouldn’t have to worry about another purchasing another plan.
The con is that Medicare Advantage plans have provider networks. If you don’t use the network of providers, you could be looking at the claim not being covered or higher out of pocket costs. You are also looking at co-pays for everything from doctor visits, days in the hospital, or lab work. There is a maximum out of pocket for Medicare Advantage plans from anywhere from $4,500 to $6,000 a year.
If you are unsure of which direction to go in with your Medicare choices, we ask that you look into your healthcare expenses over the last few years. If you have had frequent doctor visits and/or hospitalizations, a Medicare Supplemental plan may be the option that will best serve you. That’s because you will have less out of pocket expenses. On the other hand, if you have been blessed with good health and would prefer one plan to cover your Part A, your Part B, prescriptions, and extra benefits such as dental, a Medicare Advantage plan may better serve you.
It’s important to note that you cannot have two Medicare Supplemental Plans, two Medicare Advantage plans, or one of each. It’s actually against the law.
As you can see, there is much to take into consideration when looking into options for Medicare plans.
That’s why it’s important to reach out to us about three to six months prior to becoming eligible for Medicare. This way, you will have plenty of time to go through your options, ask questions about the coverage, and be able to make an informed decision based on your needs.
Medicare Advantage plans can also be changed once a year during the Annual Election Period which runs from October 15th to December 7th.
Whether you choose a Medicare Supplemental Plan or a Medicare Advantage plan, Balanced Care works with every major insurance company in the states of New Hampshire and Maine. This way you can compare side by side what works to your advantage.
After all, this is your healthcare and you are the only one that knows what will work best for you.
Terri Trepanier is the owner of Balanced Care Health and Supplemental Insurance and a licensed insurance consultant and broker with Associated Brokers. Licensed in both Maine and NH, her specialty is working with small businesses, individuals, and families with their health and life insurance needs. She is certified to offer health plans both on and off the exchange and is contracted with every health insurance company that offers plans in both New Hampshire and Maine. Her other passion is assisting Medicare beneficiaries with their Medicare Supplemental, Medicare Part D Prescription Drug Plans, and Medicare Advantage plans. Terri has seen firsthand the importance of insurance products and how they help families. Her goal with Balanced Care is to “Insure Security and Peace of Mind One Family at a Time”.