Medicare Advantage & Medigap: What’s the Difference?

There are some healthcare costs that Original Medicare (Medicare Part A and Medicare Part B) won’t pay. To help with these, many Medicare users enroll in a Medicare Advantage Plan or Medicare Supplement Insurance policy (Medigap). However, you may not have both a Medicare Advantage Plan and Medigap at the same time. So if you want coverage beyond Original Medicare, you will have to make a choice.

Healthpilot can help. Healthpilot can search many of the Medicare Advantage and Medigap plans available in your area to find the right one for your specific healthcare needs. It’s fast, easy, secure, and all online. Now, here are the key differences between Medicare Advantage and Medigap.

Plan Medicare Advantage Medigap
What is it?
Note: Medicare Parts A and B are required to have Medicare Advantage or Medigap.
Medicare Advantage includes all the services covered under Medicare Part A, and Part B. Learn the basics of Medicare here.

Many plans cover routine dental care, vision care, and prescription drugs.

Medigap helps pay your share of medical expenses like co-pays, deductibles, and coinsurance after Medicare pays for services covered by Part A and Part B.
How does it work? Your doctor sends the bill to your Medicare Advantage plan.

The amount you pay for services (co-pays, deductibles, etc.) is set by your Medicare Advantage plan and approved by Medicare.

Your doctor sends the bill to Medicare.

Medicare pays its share, then passes the rest of the costs to your Medigap plan for payment.

Cost Low or no monthly premium. But you do have to pay cost-sharing (co-pays, deductibles, etc.).

Note: You must still pay your Medicare Part B premium.

Can be a great option for people who are primarily concerned about paying high premiums.

Cost can change from year to year.

Medicare Advantage Plans have an annual maximum out-of-pocket cost (MOOP) which limits the total amount of money you have to pay in a year for Medicare Part A and Part B.

Higher monthly premium than Medicare Advantage, but your out-of-pocket cost-sharing is very predictable.

Medicare Supplement insurance plans and what they cover are fully standardized. (For example, one plan F covers the exact same things as another plan F from another carrier.)

Can be a great option for people who are primarily concerned about paying high out-of-pocket costs if they get sick.

Drug coverage Often includes a Medicare Part D Prescription Drug Plan. Convenience of one card for Medicare Parts A, B, and D. Does not include drug coverage, but you can easily add a Medicare Part D Prescription Drug Plan.
Additional Benefits May include routine dental and vision care, gym discounts, and reimbursement for medically necessary transportation. Some Medigap plans cover care when you travel outside the U.S.

While Medigap does not cover dental or vision care, some plans offer a dental or vision discount program. You can also purchase separate plans for these services.

Network With HMO plans, you must use in-network doctors and choose a primary care physician.

With PPO plans, you can see a doctor out of network but pay more.

Seeing a specialist may require a referral.

More freedom of access.

No primary care physician required. No networks.

If your doctor takes Medicare, they will also take your Medigap plan.

When to Enroll
Most people become eligible for Medicare three months before turning 65. If you are disabled, you can become eligible earlier.
You can enroll in Medicare Advantage during one of Medicare’s enrollment periods. Learn which enrollment period is right for you here. The best time to get a Medigap policy is during your Medigap Open Enrollment Period (OEP). Your Open Enrollment Period starts when your Medicare Part B coverage goes into effect and ends six months later.

If you apply for Medigap after your Open Enrollment Period, your premiums may increase, or you may be denied Medigap coverage completely due to your health status. These rules vary by state.

 

Ready to get your Medicare plan recommendation?  Come to Healthpilot today!

 

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Financial Advisor’s Guide to Medicare Advantage & Medigap

Healthcare costs make up a large (and growing) portion of your clients’ annual expenses.  But finding the right Medicare plan to protect your clients’ assets doesn’t happen by accident. As their financial advisor, you need to guide them.

The good news? You don’t have to be an expert to help them choose the right coverage. Healthpilot does that for you.  After a referral from you, Healthpilot can search many of the Medicare Advantage and Medigap plans available to your client to find the right one for their healthcare needs. It’s fast, easy, secure and all online.

Consumers may not have a Medicare Advantage and a Medigap plan at the same time. So if your clients want coverage beyond Original Medicare, they will have to make a choice. Here are the key differences you need to know.

Plan Medicare Advantage Medigap
What is it?
Note: Medicare Parts A and B are required to have Medicare Advantage or Medigap.
Medicare Advantage includes all the services covered under Medicare Part A and Medicare Part B. Learn the basics of Medicare here.

Many plans cover routine dental care, vision care and prescription drugs.

Medigap helps pay your share of medical expenses like co-pays, deductibles and coinsurance after Medicare pays for services covered by Part A and Part B.
How does it work? Your doctor sends the bill to your Medicare Advantage plan.

The amount you pay for services (co-pays, deductibles, etc.) is set by your Medicare Advantage plan, and approved by Medicare.

Your doctor sends the bill to Medicare.

Medicare pays its share, then passes the rest of the costs to your Medigap plan for payment.

Cost Low or no monthly premium. But you do have to pay cost-sharing (co-pays, deductibles, etc.).

Note: You must still pay your Medicare Part B premium.

Can be a great option for people who are primarily concerned about paying high premiums.

Cost can change from year to year.

Medicare Advantage Plans have an annual maximum out-of-pocket cost (MOOP) which limits the total amount of money you have to pay in a year for Medicare Part A and Part B.

Higher monthly premium than Medicare Advantage but your out-of-pocket cost-sharing is very predictable.

Medicare Supplement insurance plans and what they cover are fully standardized. (For example, one plan F covers the exact same things as another plan F from another carrier.)

Can be a great option for people who are primarily concerned about paying high out-of-pocket costs if they get sick.

Drug coverage Often includes a Medicare Part D Prescription Drug Plan. Convenience of one card for Medicare Parts A, B and D. Does not include drug coverage, but you can easily add a Medicare Part D Prescription Drug Plan.
Additional Benefits May include routine dental and vision care, gym discounts and reimbursement for medically necessary transportation. Some Medigap plans cover care when you travel outside the U.S.

While Medigap does not cover dental or vision care, some plans offer a dental or vision discount program. You can also purchase separate plans for these services.

Network With HMO plans, you must use in-network doctors and choose a primary care physician.

With PPO plans, you can see a doctor out of network, but pay more.

Seeing a specialist may require a referral.

More freedom of access.

No primary care physician required. No networks.

If your doctor takes Medicare, they will also take your Medigap plan.

When to Enroll
Most people become eligible for Medicare three months before turning 65. If you are disabled, you can become eligible earlier.
You can enroll in Medicare Advantage during one of Medicare’s enrollment periods. Learn which enrollment period is right for you here. The best time to get a Medigap policy is during your Medigap Open Enrollment Period (OEP). Your Open Enrollment Period starts when your Medicare Part B coverage goes into effect and ends six months later.

If you apply for Medigap after your Open Enrollment Period, your premiums may increase, or you may be denied Medigap coverage completely due to your health status. These rules vary by state.

Learn more about Healthpilot for financial advisors.

Let’s talk about what partnering with Healthpilot can do for your business. Email our Healthpilot Partner Success Team at [email protected].

 

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5 Reasons Your Medicare Plan Needs A Check-Up Every Annual Enrollment Period

Medicare’s Annual Enrollment Period (AEP) is here again, and, once again, too many Medicare users will make a big mistake — failing to use this opportunity to shore up their healthcare coverage, save money and protect their wealth. Fortunately, you don’t have to make that mistake.

The Annual Open Enrollment Period (October 15 to December 7) is the best time of year to review your Medicare coverage and make the changes you need. To take advantage of it, first, you need to understand all the changes you can make during this time. No other time of year offers so many possibilities.

Here’s what you can do during the Annual Enrollment Period:

  • Switch from Original Medicare to a Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan to Original Medicare.
  • Switch from one Medicare Advantage Plan to another.
  • Enroll in a Part D prescription drug plan.
  • Switch from one Part D prescription drug plan to another.
  • Leave a Part D prescription drug plan.

If you don’t give your plan a check-up in January you may discover that your current plan raised costs more than you expected or stopped covering one of your prescriptions. That’s why it’s so important to give your plan a check-up and shop Medicare plans every year. (If you’re feeling left out because you don’t even have your first Medicare plan yet, read “New to Medicare? Here’s why everyone’s talking about the Annual Enrollment Period.”)

Here are 5 reasons why your Medicare plan needs a check-up every year:

  1. Medicare plans change every year.
    Your Medicare plan can change a lot from year to year. Your premiums may increase. Your drug plan may introduce new medications and stop covering others. If you have Medicare Advantage, one of your doctors may move out-of-network. All sorts of changes are possible, so you need to be aware of them. Look for the Annual Notice of Change letter from your Medicare plan every year at the end of September. The letter will summarize all the changes to your coverage that will go into effect on January 1. Note: Medicare Supplement Insurance policies (Medigap) do not change from year to year. The coverage will remain the same as long as you hold the policy.
  1. Your healthcare needs change, too.
    The coverage you had last year may not be the coverage you need this year. Have you developed any new medical conditions since you enrolled in your last Medicare plan? Are you seeing any new specialists? Or have you successfully treated a condition so that it is no longer an issue? If so, consider whether your Medicare plan has given you what you need during these changes.  The Annual Enrollment Period is the time to find out if there is a better plan for your current needs; just waiting for you to find it.
  1. You could save a lot of money.
    According to a study by the Kaiser Family Foundation, about half of those who used Medicare’s Annual Enrollment Period to explore their plan options cut their premiums by at least 5 percent. Don’t stand on the sidelines. You could be missing out on significant savings.
  1. If you miss the Annual Enrollment Period, you may have to wait to make changes.
    If you discover you are not happy with your drug plan after December 7, you may have to wait until October to switch to another drug plan. You may also have to wait until October if you want to enroll in a Medicare Advantage Plan.
  1. There are lots of options out there now.
    That’s a good thing. If your current plan doesn’t work for you anymore, you have plenty of alternatives to choose from. Here’s another good thing: you don’t have to sort through all those plans yourself. After all, we could be talking about dozens of Medicare plans, depending on where you live. Just go to Healthpilot and answer a few questions about how you use healthcare. Then we’ll search available plans and recommend a selection of plans that meet your specific healthcare needs.

Give your Medicare plan a check-up this AEP.

Medicare’s Annual Enrollment Period is a great opportunity to make sure you still have the right Medicare plan. But too many people pass up this opportunity and end up stuck with plans that are too expensive or don’t provide enough coverage. Make sure you aren’t one of them.

You can take full advantage of this enrollment period every year to make sure you have the right coverage, and you can do it in a matter of minutes. Healthpilot is a free website that makes it easier to shop for Medicare plans without any obligation to enroll. Our technology predicts what coverage you would get from each available plan and what it could cost. We look beyond copays and premiums to factor in things like deductibles and coinsurance, too. You can then review your estimated out-of-pocket costs and savings for each plan compared to Original Medicare, also known as Medicare Part A and/or Medicare Part B.

Once you choose a plan, you can enroll without leaving Healthpilot.com. And if you do enroll in your Medicare plan through Healthpilot, we’ll alert you if a plan that may be better for you becomes available.


Healthpilot.com is free with no obligation to enroll. Healthpilot.com is owned and operated by Healthpilot Technologies LLC, a licensed health insurance agency, also doing business as Healthpilot Insurance Services in the state of California.  Healthpilot is not connected with or endorsed by the U.S. government or the federal Medicare program.  This article is a solicitation of insurance.

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Medicare: How to find the right plan.

The way we shop for Medicare plans today is, in a word, nuts. You spend weeks, maybe months, researching Medicare online and making calls. Then, when you find a Medicare plan you want — whether because it’s the right one or because you just can’t search any longer — it takes more paperwork and phone calls to enroll. It’s time-consuming, it’s frustrating, and it can keep you from making the best Medicare choices.

Today, there is a faster, easier way to find a Medicare plan you can be confident in. Healthpilot is a free website that makes finding a Medicare plan easier by recommending the most optimal Medicare plans for your specific needs and letting you enroll in minutes. And there’s no sales pitch for any plan, ever. Medicare Annual Enrollment starts October 15 and runs until December 7. Now is the time to discover Healthpilot and learn more about your Medicare options.

 

First, Some Medicare Basics.

You don’t have to be a Medicare expert to use Healthpilot. But if you’re new to Medicare, learning a little about the program can help you choose the right plan.

Medicare is the health insurance program run by the federal government for adults aged 65 and older and for people with disabilities or certain health conditions. It helps people pay for hospital care, doctor visits, and prescription drugs. Medicare has various “Parts.” They are:

Medicare Part A covers hospital care and services. This includes coverage for in-patient hospital stays, care received in a skilled nursing facility or rehabilitation center, and more.

Medicare Part B covers physician services and other outpatient treatments such as x-rays, lab tests, and medical equipment like wheelchairs and walkers. Part B also covers preventive services.

Note: Together, Medicare Part A and Part B are often referred to as “Original Medicare.”

Medicare Part C, also called Medicare Advantage, is an “all in one” alternative to Original Medicare. This includes coverage from Medicare-approved private insurance companies. When you enroll in a Medicare Advantage Plan, you still have Medicare.  These bundled plans include all the services covered under Part A  and Part B, and may also include Medicare Part D coverage. Some Medicare Advantage Plans include extra benefits — such as routine dental, vision, and hearing exams that Original Medicare does not cover.

Medicare Part D helps pay for prescription drugs. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. It is optional and offered to everyone with Medicare. Part D prescription drug coverage is available through a standalone drug plan or through a Medicare Advantage Plan that includes drug coverage.

Medicare Supplement Insurance, also known as Medigap, helps pay your portion of medical expenses like copays, deductibles, and coinsurance. These policies are offered by private insurance companies to supplement Original Medicare coverage. Some Medicare Supplement Insurance policies also cover care when you travel outside the U.S.

When to Sign Up.

Most people become eligible for Medicare on the first day of the month they turn 65. To make a smooth transition from your employer plan to Medicare, you must sign up during the Initial Enrollment Period (IEP), which starts three months before you turn 65 and ends three months after. (If you are collecting Social Security, you will already be enrolled.)

If you want to keep working and stay on your employer’s health plan after 65, you can delay signing up for Medicare with no penalty. When you’re ready to leave your employer’s plan, you must sign up for Medicare during the Special Enrollment Period (SEP). This period starts the month after your employer coverage ends and lasts for eight months.

Medicare Annual Enrollment Period (AEP).

AEP occurs annually from October 15 to December 7. During this time, you can join a Medicare Advantage Plan or leave a Medicare Advantage Plan and get Original Medicare or switch to a new Part D prescription drug plan.

If you want to enroll in a Medigap policy, you can do so at any time of the year.

Medicare Plans Have Costs, Healthpliot Doesn't.

There is no premium for Medicare Part A if you have paid Medicare taxes for at least 10 years (40 quarters). If not, you will have to pay a monthly premium. Medicare Parts B and D and Medigap policies require monthly premiums. Medicare Advantage Plans (Part C) have costs, but these may or may not take the form of a monthly premium. If you have a high income, you may be subject to IRMAA (income-related monthly adjustment amount) surcharges.

Healthpilot is free to use. When you enroll in a Medicare plan through Healthpilot, we receive a commission from the plan provider.

Make Medicare Easier with Healthpilot.

Medicare isn’t one-size-fits-all. There are different types of plans, a choice of insurance carriers, and flexibility about when you can enroll. But having all those choices doesn’t have to be overwhelming. Healthpilot is a free* website that uses smart technology to assess your healthcare needs, then recommends a variety of Medicare plans in your area to meet those needs. It’s so easy to use. You can shop Medicare plans, select a plan and enroll in about 15 minutes. Plus, help is available at any time by phone or chat.

Unbiased recommendations.

Most Medicare brokers rely on their “gut” for plan suggestions. Healthpilot recommends plans based on facts about how you and others like you use and pay for healthcare. While Medicare brokers often represent a single company and one or two plans, Healthpilot has no bias in favor of any plan, ever.

Free service with no additional plan cost.

Healthpilot is free. You pay the exact same price for your Medicare plan whether you enroll through Healthpilot, another broker, or the insurance company.

The right plan this year and every year.

Healthpilot evaluates plans each year to confirm you are always in the right Medicare plan. Healthpilot will alert you if your coverage changes or if a plan that could be better for your needs becomes available.

Ready to find a Medicare plan without going crazy? Shop Medicare plans on Healthpilot. Or learn more about your Medicare options.

*Healthpilot.com is free with no obligation to enroll. Healthpilot.com is owned and operated by Healthpilot Technologies LLC, a licensed health insurance agency, also doing business as Healthpilot Insurance Services in the state of California.  Healthpilot is not connected with or endorsed by the U.S. government or the federal Medicare program.  This email is a solicitation of insurance.