Every senior citizen in the US is entitled to enroll in the Medicare program once they reach the age of 65. Once enrolled, many common medical services (hospital stays, doctor appointments, outpatient services, and more) will be covered by either Medicare Part A, or Medicare Part B. The chart below will help outline which part of your Original Medicare takes care of what expenses.
There are some basic costs and fees associated with Original Medicare. Part B has certain low-cost premiums you can learn about on this website. The monthly premium and yearly deductible are required of everyone who receives Medicare benefits. There may be additional costs for Part A, but that depends on your employment history. If you have been employed for fewer than 10 years in your life, or a total of 40 quarters, then you will be required to pay an annual deductible for Part A benefits as well.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
More than a quarter of a million (287,565) Nebraska seniors are currently enrolled in Medicare. Of those, around 13% (37,383 individuals) prefer the Medicare Advantage program over Original Medicare. Then there are the highly popular Medigap supplemental insurance policies – 129,723 Nebraska seniors (or 45% of all Medicare beneficiaries) are supplementing their Original Medicare benefits with a Medigap insurance policy. We’ll tell you why these are so popular later on in this article. Finally, the remaining 42% of seniors have either not yet decided to supplement their Medicare coverage, or they are receiving some alternative type of supplement (likely through an employer).
Please keep in mind that you must first be enrolled in Medicare and actively receiving benefits before you can look into supplementing your coverage gaps. To check your Medicare enrollment status, click here.
Well, to make a long story short: because it could prove to be financially disastrous later on down the road if they do not. You see, although Original Medicare tries to be as comprehensive as possible, it isn’t perfect. There are certain “gaps” in coverage that you may end up footing the bill for if you rely on Medicare alone to cover all of your health care needs:
|Medicare Part A Costs||Medicare Part B Costs|
Granted, if you are newly retired and still in good health, you may feel like you don’t need to supplement your Medicare coverage. And you may be correct. But that status could very likely change in the future. You never know when a medical emergency will hit, and with health care costs on the rise, that emergency could cost you big if you aren’t prepared for it.
There are two main types of supplemental coverage available on the market for seniors who are receiving Original Medicare. One of them – by far, the most popular option in Nebraska – is Medigap supplemental insurance. These policies are the result of a collaboration between the federal government and private insurance companies to give you the most comprehensive protection against the gaps in Original Medicare coverage. The plans are named alphabetically, A-N, with the exception of plans E, H, I, and J (these were eliminated in 2010 with the Medicare Modernization Act). Each plan is universal across all 50 states, which means that only your provider and your premiums will vary by location.
This helpful chart details what each of the ten plans has to offer:
[chart category=”supplement” name=”planTypes” state=”NE” zipcode=”68516″]
Whether you call it Medicare Part C or Medicare Replacement, Medicare Advantage policies are designed to protect you from coverage gaps by replacing your Original Medicare with “equal or greater” coverage through a private health insurance company. This means that all of your current Medicare benefits, in addition to any additional coverage you purchase, is handled under a single policy through a single provider.
It is unclear as to why so few Nebraska residents have signed up with Medicare Advantage, but it might have something to do with the desire to keep their current doctors. In order to maintain competitive prices, many Advantage networks are highly restricted, forcing seniors to have to choose between more affordable health care, and losing their current doctor(s). Make sure you do some research first, especially if your current physician is important to you, before you decide to commit to a Medicare Advantage policy.
Most Medicare Advantage providers operate through Health Maintenance or Preferred Provider Organizations (HMOs and PPOs, respectively). There may be significant restrictions on your ability to receive medical care outside of your HMO or PPO.
[chart category=”advantage” name=”topHMOPlans” zipcode=”68516″ state=”NE”]
[chart category=”advantage” name=”topPPOPlans” zipcode=”68516″ state=”NE”]
At this point, you are probably starting to form questions in your mind about the differences between these two forms of supplemental coverage. Below, we’ve organized yet another helpful chart which tackles some of the most common questions people have about the difference between these two plans. To learn more, just take a look:
|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.|
Please take advantage of the directory we have included at the bottom of this page. With it, you can get helpful contact information for local offices and experts in Nebraska Medicare insurance supplements. Your health is important, which is why you should get as much information as possible before making a final decision about your Medicare benefits and coverage.
[chart category=”general” name=”usefulContacts”]
Important Medicare-Related Healthcare Terms
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