Utah Medicare Plans have many pros and cons depending on which option you go with, so today I wanted to discuss options and the positives and negatives of each.
Medicare supplement plans are exactly as described, they supplement your medicare and often pay all or part of what Medicare itself does not pay. As you may or may not know, Medicare Part A has a $1316 deductible. If you went to the hospital 5 times in a calendar year, you could potentially pay this deductible 5 times. senior Services of Utah usually recommend a Medicare Supplement plan that pay all of this deductible should something happen that requires hospitalization. Medicare Part B on the other hand has a $183 one time annual deductible and then you as the beneficiary are responsible for 20% while Medicare pays 80% after the deductible is met. Depending on the medicare supplement plan you choose, all of the 20% can be covered as well as the deductible should you choose. Choosing A Medigap Policy. The following are the pros and cons of this coverage
- There are no network restrictions. A medicare beneficiary can go to any doctor, facility or hospital that accepts medicare anywhere in the U.S. as long as they take Medicare. It really is that simple.
- Most providers take Medicare. The numbers have been stated that around 95% of providers in the country accept Medicare
- No primary care physician required. You can see who you want, when you want
- Medicare handles all of the billing and crosses over claims to your supplement company. There is a lot less gray area.
- Available in every county in the United States
- Plans can be changed at any time throughout the year as long as you qualify.
- Medicare supplements or medigap do not cover prescription drugs. Typically you will want to purchase a separate stand alone PDP or prescription drug plan. * The caveat would be any type of infused medication, or drugs administered at the doctors office or hospital. These are often covered under Part B. Your medical provider will often know, but you can reach out to Medicare to see how something may be covered
- Plan cost. Even though these plans offer great and extensive coverage, they are often expensive for those on a limited income.
- Plans are fully underwritten. This coverage is usually fully underwritten outside of the medicare beneficiaries open enrollment period, so we suggest you speak with a licensed agent
Medicare Advantage Plans or Medicare Part C are completely different than a Medicare supplement plans. When a beneficiary enrolls into a Medicare Advantage plan, these plans take over for original medicare. The beneficiary gets all th right and privileges of original medicare, often with advantages. Here are the pros and cons of this coverage
- Often times no additional premium over and above the Medicare Part B premium. (plans vary by county and are not available everywhere)
- Coverage looks very similar to what you may have had under a traditional healthcare plan through an employer group or standalone plan.
- Often includes part D prescription drug coverage as well at No additional premium
- Can include other ancillary benefits such as basic dental coverage, vision coverage including eye wear, gym memberships, and some even offer money toward transportation and over the counter items. These items and their availability will vary from plan to plan.
- Have co pays for services which tend to add up over time if you have major health concerns
- Have annual maximum out of pockets up to $6700. What that means is if you have a horrible health year, you could potentially face that much out of pocket
- Limited networks. Many of these plan are HMOs or PPOs and require that you choose a primary doctor. You are also required by many of the plans to get a referral from you primary care doctor to see a specialist. This can be limiting if you have a lot of health issues.
- Changing coverage can usually only happen once per year, unless you are considered to be low income and receive extra help from social security. A beneficiary must make sure they make the right choice or have the right adviser to guide them through their options.
As you can see, there are certainly pros and cons of both medicare supplements and medicare advantage plans. Senior Services of Utah feels it is important that you understand all of your Utah Medicare plans, so you can make an informed decision about what is best for you. Your health can often be a moving target, and we want to make sure you are prepared for what may come. Keep in mind, even though it might appear that once you get on a plan you are locked in, but often there are reasons why a plan can be changed. Don’t hesitate to contact us for more details and a comprehensive Medicare coverage review.
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