Any US citizen at least 65 years of age (or older) has the option to enroll in the government-managed Medicare Program. The basis of this program involves two essential parts: Medicare Part A, and Medicare Part B. Part A covers many of the medical costs associated with hospital visits and stays, while Part B deals with medical treatment that takes place outside of the hospital (such as primary care, outpatient treatment, and preventive medicine). These two parts are also referred to as Original or Traditional Medicare pretty frequently.
Coverage and Benefits
The costs are designed to be relatively low for retired individuals living on a fixed income. Part B has its own monthly premium, which can be calculated on this page. For many retirees, the premium charges for part A can be waived if you have a minimum ten-year (or forty-quarter) employment history. Otherwise, you will have to pay a premium charge for access to Part A benefits if you have a shorter employment history.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Medicare Beneficiaries in Georgia
The entire state of Georgia contains 1,318,733 Medicare beneficiaries. Of those, more than one-fourth (28%, or 369,245 people) have replaced their Traditional Medicare policy with a Medicare Advantage plan. Beyond that, 239,223 Georgia residents (18%) are currently supplementing their Medicare Parts A and B with a Medigap plan. The remaining 54% have some other form of supplementation, such as employer benefits, or are relying on Medicare alone to meet their health care needs.
Medicare supplement policies are only available to seniors 65+ who have successfully enrolled in the national Medicare program. Information on enrollment, status, and eligibility can be found on the federal Medicare website.
The Benefits of Supplementing Original Medicare
Many different individuals can benefit from supplementing their Medicare policy. Even if you are newly retired and enjoying exceptional health, there are still gaps in Traditional Medicare which can leave you with unexpected medical bills. For example:
|Medicare Part A Costs||Medicare Part B Costs|
The older you get, and the more chronic health conditions you have, the more expensive that these gaps in Traditional Medicare will become. For these reasons, people often choose to supplement their Medicare policy. That extra bit of coverage and extra expense gives them piece of mind and protection from unpaid medical expenses down the road.
How are Medigap Policies Different from Medicare?
Traditional Medicare and Medigap are two completely separate forms of coverage. However, Medigap policies have been specifically designed to work with Original Medicare. They have been crafted to fill in the coverage “gaps” of Medicare – hence the “gap” part of “Medigap” – to protect you from unexpected costs. The Alphabetically-named plans are A, B, C, D, F, G, K, L, M, and N. The Medicare Authorization Act, passed in the summer of 2010, phased out the superfluous plans E, H, I, and J. It is also worth mentioning that Plan A in Nebraska has the exact same benefits as Plan A in Georgia; the only elements which vary by region are the price, and the providers.
Take a look at what Medigap Plans A-N have to offer:
How Is Medicare Advantage Different from Medicare?
Medicare Advantage both is, and is not, a part of traditional Medicare. That may sound confusing, so let’s try to clear the air: Medicare Advantage is sometimes referred to as Medicare Part C, which technically makes it a part of the Medicare Program. At the same time, however, it is its own separate form of coverage. So separate, in fact, that your medical claims will not be paid out by any government entity. Instead, they will be paid out by whatever private insurance company you purchase your Medicare Advantage plan from.
The good news is that no matter what Advantage plan you buy, you will at the very least still receive the same benefits you would be getting from Original Medicare. Your private insurer cannot take those away from you, because they are protected by federal law. Additionally, you may receive other benefits such as vision or dental if your insurer offers them at a price you can afford. Unfortunately, the low costs of such plans come from your insurance company working with a small number of doctors within a limited network. So you may be getting additional coverage at a potentially lower cost, but many Medicare Advantage beneficiaries end up losing their preferred doctors as a result.
Also, for clarification purposes: an HMO plan stands for “Health Maintenance Organization”, and a PPO plan is short for “Preferred Provider Organization”.
The Real Differences between Medicare Advantage and Medigap
It can be difficult to determine which supplemental policy will meet your medical care needs at a cost that won’t ruin your budget. Take a look at the table below. It will help explain some of the key differences between each plan, as well as give you an idea of what you might be expected to pay for vs. what should be covered.
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
The More You Know About Medicare Plans in Georgia
So far, we’ve covered enough of the basics to help get you started. But knowing the basics can only get you so far. For the next leg of your journey, you’ll need to ask the right people the right questions based on your own individual medical concerns and requirements. Please take advantage of the directory we’ve included below, as well as other relevant resources for Medicare supplement plans in Georgia.
Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.