Medicare seems complicated at first glance, but it can be easily broken down into a few basic sections.
If you have Medicare, you have parts A and B. Part A covers hospital visits, and Part B covers doctor visits. The next step is deciding between Medicare Advantage and Medicare Supplements.
Medicare Advantage is how we refer to Part C. In simplest terms, Part C is a combination of Parts A and B, but it also includes other need-based benefits. The only piece of Original Medicare that is missing from Medicare Advantage is hospice coverage. Plans also commonly include Part D, which is prescription drug coverage.
You cannot be denied for Medicare Advantage once you have Original Medicare, though clients with end-stage renal disease (ESRD) may not qualify. So why wouldn’t a qualifying client want Medicare Advantage/Part C?
Medicare Supplement plans, commonly referred to as Medigap, are another great option. Medigap helps to pay for Original Medicare and helps to cover deductibles and co-insurance. However, it does not include dental, hearing, or vision, and you can be denied coverage based on your medical history if you wait until more than 6 months after you turn 65 to enroll.
There are clear benefits to both Medicare Advantage and Medicare Supplements, but clients cannot receive coverage from both. Additionally, remember that Medicare Advantage is an alternative to Original Medicare, not an extension of it. However, Medicare Supplements are an addition to Original Medicare.
Medicare Supplement plans generally appear more expensive but can help to pay the costs of Original Medicare. Still, every client will not have the same costs. You should consider deductibles, monthly premiums, regularly used prescription drugs, anticipated hospital and doctor services, and plan limits on out-of-pocket costs when determining financial burden. Also remember that some doctors, hospitals, and pharmacies will not accept certain plans. Make sure you ask your client where they receive care.
Medicare Advantage plans usually have trial periods of up to a year. If a client is unsure of their medical needs, this is a good way for them to figure out if MA is right for them. After the trial period, the client has the right to purchase a Medigap/Supplement plan instead.