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Medicare Supplement and Medicare Advantage Frequently Asked Questions
Frequently Asked Questions:
Medicare Supplement (Medigap) vs Medicare Advantage (Medicare Part C)
Why should I look into a Medicare Supplement (Medigap) or Medicare Advantage plan (Medicare Part C)?
Original Medicare doesn't cover all of your medical costs, which leaves you paying out of pocket.
With a Medicare Supplement (Medigap) plan, you can get additional coverage to help pay copayments, coinsurance, and deductibles.
With a Medicare Advantage plan (Medicare Part C), you can get additional coverage including Medicare Part D (prescription drug coverage) and extra benefits like some vision, hearing, dental, routine exams, and more.
There is no distinct "better option" when comparing Medigap and Medicare Advantage. Every individual has different needs for their medical coverage, and these needs will determine which plan is better for you.
In general, Medigap helps to pay out-of-pocket costs that are not covered by Original Medicare as well as some services not included in Original Medicare. Generally speaking, Medigap does not cover long-term care, vision, dental care, hearing aids, eyeglasses, or private-duty nursing.
Medicare Advantage, also known as Medicare Part C, doesn't "supplement" your Original Medicare plan - it replaces it. This plan is provided by Medicare-approved private companies that must follow rules set by Medicare. Medicare Advantage plans cover most of the Part A and Part B services from Original Medicare, but depending on the plan you choose, you can also get coverage for some vision, hearing, dental, and Medicare Part D prescription drug coverage.
Medicare Supplement (Medigap)
Medicare Supplement Insurance helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medigap policy can help pay some of the remaining health care costs, like: copayments, coinsurance, deductibles.
- Medicare Supplement Insurance plans can help cover costs like deductibles, coinsurance, and copayments.
- Some Medigap plans can virtually eliminate your out-of-pocket costs.
- If you enroll in the open enrollment period after you turn 65, insurance companies can’t exclude you based on health conditions.
- Medigap plans D, G, M, and N will cover 80 percent of emergency healthcare services for certain medically necessary emergency care when you’re traveling outside the United States as long as Medicare doesn't otherwise cover the care, care begins during the first 60 days of your trip, and your $250 deductible for the year has been met. (Foreign travel emergency coverage with these Medigap policies has a lifetime limit of $50,000).
- Many different plan options to choose from to best suit your individual healthcare needs.
If any of the following apply to you, then you are almost guaranteed "eligible" to purchase Medicare Supplement Insurance:
- You are currently covered under Medicare Parts A & B
- You are within 6 months of turning 65
- You are within 6 months of receiving Part B coverage
- If you are about to lose your group health insurance plan
Please note that you may still be required to answer some medical questions about your overall health and wellness.
Medicare Advantage (Medicare Part C)
Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs.
- You still get complete Medicare Part A and Part B coverage through the plan.
- Some plans offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental.
- Your out-of-pocket costs may be lower in a Medicare Advantage Plan. If so, this option may be more cost effective for you.
- You can join a Medicare Advantage Plan even if you have a pre-existing condition.
- Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services.
There are 3 general eligibility requirements to qualify for a Medicare Advantage plan (Medicare Part C):
1. You must be enrolled in Original Medicare (Medicare Part A and Part B).
2. You must live in the service area of a Medicare Advantage insurance provider that is accepting new users during your application period.
There are 4 common Medicare Advantage plans, which include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs (SNP)
These plans vary in regard to costs, where you can receive care and services, prescription drug coverage, primary care doctors, referrals, and more.
In addition to these 4 plans, there is also HMO Point of Service (HMOPOS) or Medicare Medical Savings Account (MSA).
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Located in the heart of Atlanta, eQuoto is comprised of a group of senior insurance experts. During our tenure, we have helped thousands of Americans purchase Medicare Supplement and Advantage insurance. We are an independent company and we don't belong to a specific insurance carrier. We connect you with licensed insurance agents who can help you find the best coverage for your Medicare needs.
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