Medicare Fork in the Road

So, you’ve turned 65 and you’re wondering, “What now in terms of my Medicare insurance?”

Well, some folks are still covered at their job, and they can continue that coverage in some instances, but in many cases, it makes sense to let go of that coverage b/c there could be significant cost savings or you may improve your coverage (get with me if you have those questions).

For most folks, they find themselves at a Medicare Fork in the Road. Simply put, do they want to use Original Medicare with a Supplement (Plan F, Plan G, Plan N, etc.) OR do they want to use a Medicare Advantage plan which stands in place of your Medicare coverage. Clear as mud?

What are the differences?

Original Medicare with a Supplement: In the interest of space and time, Medicare is an 80/20 program. They pay 80%, you pay 20%. Not bad coverage, but Medicare does not cap that 20% so it can be risky – unless you have a Supplement. They are denoted by letters (Plan G, Plan N, etc.). These are designed to pay the full 20% and eliminate most of your out-of-pocket expenses while using the coverage. Some have small deductibles and co-pays. You can use them anywhere Medicare is accepted and are offered by private insurance companies. Allows for easy travel and very few restrictions. A great option for many seniors.

Medicare Advantage: These are plans that are meant to stand in the place of your Medicare coverage. If you elect to use an Advantage plan, then put your Medicare card away. It’s a bundled plan that includes Medical and RX. They usually have some sort of network that you need to abide by and can have prior authorization rules and referral requirements. There are usually a handful of plans (depending on zip code) you can choose from, and no two plans are the same. Typically, you can expect to have more expenses on an advantage plan and every plan has a “Max out of Pocket” – this is the most you can spend on the plan per year (excludes drug cost). Advantage plans can be a great option for folks who would struggle with a monthly premium and want an all-in-one solution.

Both options have their place in this market and each plan works differently so make sure it suits your needs! There are other things to consider when comparing these two options so don’t hesitate to reach out to me at (972) 393-5080.

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