Recently we had a scenario where a disabled Medicare beneficiary had a Medicare Supplement policy that had received increases over 4 years. His premium had reached over $400 per month or $4,800 per year. We realized that he had over 10 years to go before reaching his “Open Enrollment Period” which allowed him to change to a different Medigap Policy. So we found a way to save him money through a Medicare Advantage Plan and had a way to guarantee he did not spend any more than $4,800 per year.
Medicare Advantage Plan – Benefit Structure
MA Plans provide different benefit structures by county in each state. While a Medicare Supplement provides the same benefits in 47 states across the country; A Medigap policy may have different state laws that can adjust the application process but not the coverage.
Medicare Advantage Plans also known as “MA or MAPD” plans can include drug coverage while Medicare Supplement plans can not include drug coverage. Medicare Advatage Plans will usually offer their benefits through PPO Plans, HMO Plans, PFFS Plans, SNP Plans and Dual Eligible Plans. In essence these plans will determine benefit structures, premiums, and provider directories. It is very important to review the Summary of Benefits before enrolling in a plan.
Medicare Advantage Scenario
The Medicare Supplement example above is a great example where a Medicare Advantage plans should be considered. His premiums had gone up to $400+ per month and the Medicare Advantage Premium was $0 per month with a $4,900 out of pocket max per year, plus it included a Prescription Drug Plan.
After checking the Medicare Advantage Carrier’s website to verify his doctor and hospital were in the PPO network we learned that he only visits the doctor two times per year and hasn’t been into the hospital in 8 years. So if this continues for the following year his premium will be $0, the two doctor visits would cost him $30, and even if he went to the hospital one day it would cost him $225 per day. So he is looking at $255 in costs for the year instead of $4,800 guaranteed cost.
Medicare Supplement vs. Medicare Advantage Plan
These plans are very different but both can provide excellent coverage depending on the situation. If you are wanting full coverage a Medicare Supplement is the way to go if you can qualify. If you are looking for coverage that is less expensive with only 1 health questions a Medicare Advantage Plan would be up your alley.
Call MWG Senior Services at 800-800-1397 option 6 for your Medicare Insurance Quotes.