Medicare is a federal government health care plan which all citizens 65 years of age or older are eligible to join. The basic plan that most people refer to when they talk about Medicare actually comes in two parts: Medicare Part A, and Medicare Part B. You may also hear them referred to as “Traditional” or “Original” Medicare. While both parts A and B are intended to cover most of your health care needs, there are sometimes gaps in the plan which may require additional coverage.
There are some basic costs associated with Original Medicare. Part B requires a monthly premium, regardless of your circumstances. Part A might require a premium also, but that depends largely on your employment history. If you have worked for at least ten (10) years or at least forty (40) quarters, Part A is free. If your employment history is shorter than that, you may have to pay an additional charges. Click here for more information on Part B costs.
You’re practically guaranteed Medicare benefits if you apply within your specific window after turning 65 years old. Once you qualify, you will start receiving – and be required to pay a premium for – your Part A benefits. But you don’t have to accept Part B benefits (or pay for them) right away. In some situations, Part B maybe completely optional. But if you don’t accept Part B, you will have to find another way to pay for doctor visits, medical supplies, and outpatient treatment.
Medicare Part C is 100% optional. However, if you choose to accept Medicare Part C instead of Medicare Parts A & B, There are some benefits which you cannot opt out of. Medicare Part C plans automatically come with the exact same benefits that you would get from Original Medicare (Parts A & B). Aside from optional coverages like prescription drugs, dental, or vision, you cannot choose to accept fewer benefits than the base package. Similarly, if you decide to stick with Original Medicare and decide to add Part D coverage, you must also accept Part B benefits. You cannot have only Part A and Part D benefits at the same time.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Delaware Medical Plans: A Breakdown
Within the state of Delaware, there are 157,289 residents currently enrolled in the Medicare benefits program. Of those, a meager 7% (11,010) of people have instead chosen a Medicare Advantage plan. However, 32,593 people – nearly three times the number of Medicare Advantage enrollees – have chosen to supplement their Medicare benefits with a Medigap policy instead. But these popular Medicare supplement policies are only protecting 27% of the Delaware population in total.
The remaining 73% are either relying on alternative sources for health care coverage, such as an employer plan, or risking their financial future by relying on Original Medicare by itself to cover their health care needs. Keep in mind that these numbers only represent seniors 65 and over who are currently enrolled in Medicare.
Delaware may be a relatively small state, but healthcare costs are far from diminutive – especially when it comes to senior care. Understandably, this becomes extremely problematic when you are no longer working and instead of getting by on a fixed income. Medicare benefits do a great job of helping seniors cut their healthcare costs down to a manageable level. But there are other supplements out there that can assist seniors like you even further.
The two most popular options for supplementing Medicare Parts A & B are either Medicare Part C, or a Medicare supplement insurance policy. Medicare Part C is also sometimes referred to as a Medicare Advantage plan; likewise, Medicare supplement insurance policies are also known as Medigap policies. Unfortunately, the confusion doesn’t end there.
We know what you might be thinking: why is it so important to get a Medicare health insurance supplement? Doesn’t Medicare cover all of my needs? Unfortunately, the answer to that question is no. There are some little-known gaps in both Part A and Part B coverage which can cost you thousands if you aren’t careful. That’s where Medicare supplements come in. They help share that burden with you so that your savings and finances are protected. If you have yet to enroll, click this link to learn more about Federal Medicare benefits.
If you are unfamiliar with Medicare supplements, you have come to the right place. It’s important to understand the distinction between these two types of coverage. For starters, Medicare Advantage is a private health insurance plan which you purchased from an independent company. Your health care will no longer be managed by the government. Medicare supplement plans, on the other hand, do not usurp Medicare; they simply add a little bit of private health insurance coverage onto your federal Medicare benefits. They work with the government, not in place of them.
How Important Are Medicare Supplement Policies?
Depending on your circumstances, they can be essential to managing your health care needs at the most affordable cost. If something unfortunate were to happen, such as an extended hospital stay or months of rehab from a physical injury, you might be required to pay some hefty out-of-pocket prices which Traditional Medicare won’t cover. Such as:
|Medicare Part A Costs in 2022||Medicare Part B Costs in 2022|
For many, especially those who are well into their golden years and living on a fixed income, leaving their health care coverage to chance is a gamble they cannot afford to make. Obtaining supplemental health insurance helps protect them from the gaps in Medicare, and eases their worries. There are two main options for supplementing Medicare which we will get into presently: Medicare Advantage, and Medigap.
Medigap Coverage: Pros and Cons
Medigap is the shorthand term for Medicare Supplement plans. It’s a sort of nickname used to reflect the fact that these policies are designed to cover the “gaps” in Original Medicare. The federal government, with Medicare gaps in mind, has designed and continues to regulate these plans to work optimally with existing Medicare coverage options. The plans are organized alphabetically: A, B, C, D, F, G, K, L, M, and N. During the summer of 2010, plans E, H, I, and J were phased out of the program due to the Medicare Modernization act. By law, each plan provides the same benefits and coverages in every state; meaning that what you get for plan A in Delaware will be the same as California or Texas. The only difference will be in how much you pay for the policy.
Below is a handy chart which explains the benefits of each individual plan:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$125||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$124||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$134||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$96||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$83||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$95||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$72||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$72||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$43||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$124||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
The Pros and Cons of Medicare Advantage
Medicare Advantage (also Medicare Part C) acts more like a replacement of Original Medicare than a supplement plan. This is because, with Part C, a private insurance company takes over responsibility for paying out your claims; they are no longer paid for by the federal government. However, there are laws in place to protect you. These laws mandate that whatever private company underwrites your coverage offers you the exact same benefits as Traditional Medicare (or better). They are not legally permitted to offer you anything less.
Some companies take advantage of this and dress up their Medicare Advantage policies to include enticing extras, such as prescription drug coverage or dental. Such a policy will likely cost more than Original Medicare but could save you thousands in the long run. However, in order to provide affordable extras, Medicare Advantage plans tend to have limited networks. The risk of losing your current doctor (or doctors) by switching to Medicare Part C is a significant one that you will have to consider before signing the dotted line.
A Side-by-Side Comparison of Medigap vs. Medicare Advantage
One important distinction between Medicare Advantage and Medigap is the process by which claims are handled. With a Medigap policy, your supplement provider doesn’t step in or pay for any costs until after Medicare has handled their share of the expenses. Any remaining costs are then dealt with via your Medicare supplement insurance before you even see a bill – If you ever see one at all.
Medigap supplements and Medicare Advantage are both issued and underwritten by private businesses. However, unlike Medicare Part C, Medicare supplement insurance is highly standardized and streamlined. this helps get your costs covered more efficiently and helps you understand what your plan provides. No matter where you are in the country, your plan will cover the same benefits as it would in any other state. The only variable is your monthly premium.
Medicare Advantage plans are much larger, more cumbersome, and can be a little confusing at times. But they offer more benefits then a Medicare supplement insurance policy. They completely replace Medicare Parts A & B to start with. Next, your insurance company may give you the option to choose riders like vision, dental, or even prescription drug coverage. There may be even more additions than that if you choose to add them.
Pricing tends to be simpler with Medicare supplement insurance when compared with Medicare Advantage. Medigap supplements require one affordable monthly premium, and that’s it. On the other hand, because Medicare Part C is basically a private health insurance policy, your provider can change pricing and benefits at almost any time. This includes your monthly premium. Granted, the federal government will be paying most if not all of your premium directly to your healthcare provider. Leftover premium costs, co-pays, car insurance, and deductibles will be passed on to you.
But that really only skims the surface of the differences between Medicare Advantage and Medigap. We have a list of frequently asked questions below, along with some helpful information to help you get through the confusion. But you can learn even more if you contact one of our representatives today and let them assist you in finding a policy.
Everyone’s medical needs are different. While Original Medicare may be more than enough for some, there are others out there who could really benefit from a Medigap or a Medicare Advantage policy. It is up to you and your insurance agent to analyze your specific needs and figure out what type of supplement coverage you need.