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There are two ways to “plug the holes” in original Medicare Part A and Part B. Most people don’t understand the difference between the two and often they regret their decision. A description of how a supplement works is on the main page under Medicare but I did not give a description of Medicare Advantage plans or how they differ.
A Medicare Advantage plan is offered by the Federal Government but by an insurance company or a not for profit hospital system. With these “Advantage Plans” (also known as Part C) you must use the doctors in their network (or pay appreciably more for service with some plans). Their network will have almost every type of doctor imaginable but perhaps not the one you want. You must use the hospital in their network. If you want to use Hopkins but belong to Medstar you will be paying much more or if you want to use Union Memorial and belong to Hopkins same thing. It must be noted that in the event of an emergency you may go to any facility but once stabilized you will go at your own expense to a network hospital.
With Advantage plans you will likely pay $25 or so to see a primary care physician or $50 or so for a specialist. A hospitalization is in the neighborhood of $250 per day for the first week. The prices change every year.
With Supplement plans you likely are going to pay less than $200 per year for your doctors and hospital copays. Under no condition will you pay more than $2,900 for any plan that I will sell. Advantage plans have a maximum out of pocket of at least $5,000 and as much as $10,000 per year! Unlike Supplement plans you will pay fully 20% of all costs for things like chemo or radiation or pacemakers. You will pay 20% towards durable medical equipment like wheelchairs and walkers. This all counts into your annual maximum out of pocket.
When you get a Supplement policy you can do it automatically when you turn 65 (or first get Part B) after that you will have to answer health questions including whether you are a smoker. With Advantage plans the only health question is whether you are on dialysis. For this reason, Advantage plans will likely end up costing you more not less over the years even though the monthly premiums are lower.
Now nothing is right for everyone and I have certainly enrolled many people in Medicare Advantage plans but after 25 years of representing Supplements and 10 years of representing Advantage plans I can tell you without questions that I have fewer people complain or drop their supplement plans than I have people want to switch into an Advantage plan. This article is not all inclusive, this did not talk about special need plans, Medicaid, or drug plans. Please call or write to discuss.
I am linking an interesting article from the Wall Street Journal “A recent report says many buyers of Medicare Advantage plans are confused” http://www.wsj.com/articles/beware-medicare-advantage-plans-1480302660

Neither Abrams/Mendelsohn Insurance or Al Mendelsohn are connected to the US Government, the Medicare program or the State of Maryland. This is a solicitation for insurance in the State of Maryland. You may be contacted by an agent if you solicit information.

 

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