Judy H. wrote to ask me about her Medicare coverage. She says she’s confused by all the information and choices out there. She’s not alone! Should she stay with her Medicare Advantage vs Medicare Supplement (Medigap)? Or should she just do straight Medicare and pay the 20% on her own?
While I’m not a Medicare expert, I do understand some of the basics. I also did some online snooping to hopefully help guide her to finding an answer that’s right for her Here is her question and my response:
Decision Time: Medicare Advantage vs Medicare Supplement
I am on a fixed income. I am currently enrolled in a Medicare Advantage plan, specifically in Blue Cross/Blue Shield Senior Blue. My monthly premium is $109 + the $104.90 that’s automatically deducted for my Medicare. This plan includes Medicare Part D. I have co-pays for doctors, medicine + a hospital co-pay of $285 a day for the 1st 7 days in a hospital.
I’m beginning to wonder if I should just drop the Medicare Advantage plan & go with straight Medicare & pay the 20% co-pays or if I should look into a Medicare Supplement (Medigap) plan. There are dozens of supplement plans out there. It’s very confusing as to whether it pays to keep things as they are or make changes.
Thank you in advance, Ronnie Ann. Any input on my dilemma would be much appreciated.
It’s a really great question. Many people face the Medicare Advantage vs Medicare Supplement (Medigap) question every day.
Unfortunately the answer depends on your specific circumstances. Your physical condition, how much regular medical care you need, what prescription drugs you depend on, etc. But I will do my best to help guide you to finding the right answer for you.
First, I think we can eliminate Medicare on its own, with you paying the other 20%. Because of your circumstances, I think that would leave you the most financially at risk.
You say you’re on a fixed income, and according to Medicare & You (official Medicare publication) for plain old Medicare “There’s no yearly limit for what you pay out-of-pocket.” So just one expensive hospital stay or costly treatment could wipe you out — and land you in debt.
Where to start looking for help
You can find some very helpful articles by googling “Medicare Advantage vs Medicare Supplement.” These will answer some of your basic questions and provide a solid framework for going elsewhere to ask for more help. (Good to know the native lingo.)
I’d also contact your current insurance provider. Most of them can guide you through at least some of the Medicare Advantage vs Medicare Supplement issues. In addition, most communities have a non-profit or governmental organization that can help with decisions like this, since many of us find all this unnecessarily confusing.
And if you can’t find a local place for answers on your own, try calling a local government official’s office (Congressperson, State Senator, council member) and explain what you’re looking for. At least one of them should be able to point you in the right direction.
Medicare Advantage vs. Medicare Supplement (Medigap)
So now we turn to your current Medicare Advantage plan versus the Medicare Supplement (Medigap) option, of which each has … ugh … lots of additional subsets of choices. (I’ll just stick to the overview here.)
Although I wish there were a one size fits all answer, you are going to need to look at your own needs and see how well each plan serves you. To do that, I’d suggest a Pros & Cons chart for each of the two plan types.
Pay special attention to things like part D. You have it now, but if you switch, you’ll need to buy it:
“Part D premiums range from $10-$100 per month (depending on the plans available in your area and on the particular plan you choose). The maximum deductible — the amount you must pay out-of-pocket before Medicare will contribute to your prescription costs — in 2016 is $360. After you meet the deductible, Medicare will pay roughly 75% of your prescription costs.” ~ Source: Nolo.com
Also, you’ll also want to pay attention to things like deductibles for each Medicare plan option. And any annual / lifetime caps for your own spending, and whether you can choose the doctor you want. In addition, your conditions and special medical needs may play a role in what each may cost you. Or even if you qualify at all for the Medigap plan you want.
A few more thoughts
Again, a really good starting point would be your own current insurer, since I believe they have plans of both type. If not, worth a call to an insurer or two who do have the type of plan your considering.
Now you can see why figuring out the best way to go when it comes to Medicare Advantage vs Medicare Supplement (Medigap) is so hard for so many people. And again, within each there are more options to think about. For me, this is not the time to go it alone. Find good help and be patient with both the helper and yourself. 🙂
I know this sounds like (and is) a LOT of work, but hopefully you’ll get some answers that make sense for you. Good luck with your decision!
~ Ronnie Ann
NOTE: Not every area of this country offers both Medicare Advantage and Medicare Supplement (Medigap). So do a search online or you can contact your regional Medicare office to make sure what’s available where you are. For instance, I was surprised to find out that New York City only offers Advantage plans, except for a handful of extremely costly supplement plans.
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