This is called your "Medical Insurance" (sometimes referred to as "Physician Services").  Part B covers things like doctor office visits, lab tests, MRI’s, outpatient surgery, and so on.  Tap here to find out more.

Part D 

Typically covers prescription drugs that you pick up at a pharmacy.  There are only two ways to get Part D coverage. Tap here  to find out more.

Not sure which Medicare option is right for you? 

Let's take a closer look the pros and cons of Medicare supplements and Medicare Advantage plans.

Pros and Cons of Medicare Supplement (a.k.a. "Medigap") plans

Medicare supplement (also called “Medigap”) plans do exactly what the name suggests: they supplement, or ‘fill in the gaps’, of the health care costs Medicare doesn’t cover. Some people mistakenly assume that Medicare supplement plans offer benefits beyond what Medicare covers. The truth is that Medicare supplement plans follow Medicare benefits like a train and caboose. If Medicare covers a procedure or service, then a Medicare supplement plan will cover the same procedure or service – paying the portion Medicare does not pay up to plan limits. Medicare supplement plans are standardized; they offer the same benefits and provider choices regardless of the insurance company and are identified by letters A through N (tap here  for an overview of Medicare supplement plans and benefits). Premiums are the only difference between Medicare supplement plans with the same letter sold by different insurance companies. Medicare supplement plans are also very portable – meaning that you can take it anywhere in the U.S. and the benefits will be the same. There are no network restrictions, so you can see any medical provider in the U.S. who accepts Medicare and there are no referrals required to see specialist doctors. Medicare supplement plans in general offer more freedom and flexibility compared to Medicare Advantage plans.

Tap here  to get Medicare supplement rates in your area.

Things to consider regarding Medicare supplements

Medicare supplement plans have premiums that tend to be higher than Medicare Advantage plans and the premiums typically increase as you get older. The other downside is that you will also need to enroll in a standalone prescription drug plan, for an additional premium, in order to receive Part D benefits (Medicare Part D is pharmacy prescription drug coverage. To find out more about Part D,  tap here). 

Pros and Cons of Medicare Advantage plans

Medicare Advantage plans have become increasingly popular over the years for a variety of reasons. Most notably the premiums will be considerably lower than Medicare supplement plans (in some areas Medicare Advantage plans have $0 premiums) and most include Part D coverage so there is no need to purchase a standalone drug plan. Copays are fairly nominal under most plans for everything from doctor office visits to diagnostic testing, rehabilitation, outpatient surgeries and inpatient hospitalization. Plus they may also include extra benefits for things that Medicare doesn’t cover like dental, vision, chiropractic and acupuncture. Many also have free gym memberships to help keep their subscribers active and healthy. Some Medicare Advantage plans will also offer free transportation to and from doctor office visits and other medically related appointments (including to and from the pharmacy). 

Tap here for Medicare Advantage plan options and rates in your area.

Things to consider regarding Medicare Advantage plans

With a few exceptions, Medicare Advantage plans are network based plans. A majority of Medicare Advantage plans are HMO’s, which are very network restrictive. As with most HMO plans, if you go out of the network for routine care you will be responsible for the entire cost (emergency care is covered in-network for all Medicare Advantage plans regardless of where it occurs). There are Medicare Advantage PPO plans offered in a few areas but they tend to have higher premiums and out-of-pocket costs (i.e.: deductibles, copays and co-insurance) than their HMO counterparts. And even though PPO plans will cover you in the event that you want to see an out of network provider, the out of network costs are typically 50% of charges – which cost wise could be too steep for some people.

One other thing you want to be especially aware of is the “Out of Pocket Maximum” (sometimes referred to as the Annual Out of Pocket Maximum or Maximum Out of Pocket, etc.). This is the most you could be responsible for in a given year. The highest Out of Pocket Maximum that Medicare allows in 2021 is $7,550 – although many Medicare Advantage plans have much lower Out of Pocket Maximums. Ideally, if you do choose a Medicare Advantage plan, you will want a plan with an Out of Pocket Maximum as low as possible.

The Bottom Line

Some people find that their doctors are already in a network and they would prefer to save on monthly premiums. They may also be attracted to the ‘extra benefits’ that a Medicare Advantage plan offers. In these cases, a Medicare Advantage plan works well. For others, perhaps they have doctors who are not in any networks and/or they may do a lot of traveling. Maybe they live in more remote areas where their Medicare Advantage plan choices are ‘slim pickings’ to none at all. In these cases a Medicare supplement plan is much more appropriate. Typically, the right plan option comes down to three things: doctors, drugs and affordability. Will all of your doctors accept your plan? If not, would you be willing to change any of your doctors? Are all of your medications covered and at reasonable copays? Is the monthly premium(s) going to leave you strapped at the end of every month? And so on. 

Most people find it very helpful to talk to a knowledgeable health insurance agent or broker who specializes in Medicare and is appointed and contracted with many insurance companies. Agents and brokers by law are not allowed to charge consumers for advice or help with health insurance matters. Your premiums will be the same no matter if you enroll directly through an insurance company or through an agent or broker (agent and broker compensation comes from the insurance companies for the business that they write). Plus a good agent or broker will also advocate on behalf of their Medicare clients on issues that may come up down the road. 

Have Questions?

We’re here to help guide you through the Medicare Maze!

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