With a large number of options available to Medicare Enrollees, it can feel overwhelming when selecting a plan, or who to trust when looking for Medicare advice. As an Independent Broker, we are your Medicare advocate and guide. Maven Medicare partners with all of the ‘A’ rated insurance carriers, which allows us to analyze the Medicare Market and shop for the most affordable and comprehensive plan to meet your needs.
Medicare offers Part A and Part B.
-Part A covers in-patient care in hospitals, while Part B covers your doctor’s and outpatient services.
-For most Medicare Enrollees who qualify, Part A is free.
-Part B covers your doctor’s and outpatient services. It will cover 80% of your healthcare charges.
-Part B’s monthly premium for 2021 is $148.50. It has an annual deductible of $203.
-Higher Income Earners do pay a higher monthly premium- see here for more details.
Since Medicare only covers 80% of your healthcare charges, you are responsible for the 20% gap. 20% may not sound like a lot, but if you were to have a $100,000 heart surgery, you would have a $20,000 bill.
To avoid this costly issue, most people cover that 20% coverage gap with supplemental insurance.
There are only two options to cover the 20% gap:
1. Medicare Supplements (also known as Medigap)
or
2. Medicare Advantage Plans (also known as Part C. of Medicare)
Medicare Supplements (Medigap)
- Health insurance sold by private insurance companies to fill the gaps in “Original Medicare” parts A & B.
- Plan coverages are standardized by the government to offer the identical basic benefits across insurance companies.
- A Medicare Supplement plan “letter” indicates exactly what is covered.
Example: An Aetna Plan G has the exact same standardized coverage as the AARP Plan G, although their premium rates may be different. - With these plans, you may go to any doctor that accepts Medicare patients, no referrals needed. If the doctor accepts Medicare, they will take whatever brand Medicare Supplement you have.
- Medicare is accepted with 93% of doctors. (Kaiser Institute Research)
- After paying the 2021 $203 Part B deductible, Medicare Supplement Plan G offers 100% coverage anywhere Medicare is accepted. No networks, no extra fees, no maximum out of pockets to worry about.
- As long as you pay your monthly premium, you may have this plan for your entire retirement. You also may switch these plans at any time to another supplemental plan, but after your Open Enrollment, you are subject to health underwriting.
- These plans do not offer Prescription Coverage, you select a Part D Drug Plan.
Medicare Advantage Plans
- Run by private insurance companies approved by Medicare.
- With a Medicare Advantage plan, you sign away your Medicare Primary coverage, which is Medicare part A and B, to a private insurance company that will offer you a managed plan where you have a set of networks for Doctors, Specialists, and hospitals.
- These plans are locked in for one calendar year.
- May include prescription drug (Part D) coverage.
- Offered as HMO, PPO, and PFFS plans, network based plans. You are no longer on the Medicare network, but the private insurance’s network.
- Doctors can choose whether or not to accept the plan.
- Plans can change each year.
- While premiums are often as low as $0 a month, these plans have copays for their services.
- These plans have a 2021 Maximum Out of Pocket Expense of: $7,550 for in-network services and $11,300 for in-network and out-of-network services combined. The maximum out of pocket may be lower than these numbers, but does not exceed these numbers.
Part D: Prescription Drug Plans
Anyone who is entitled to Medicare Part A or enrolled in Medicare Part B can join a Medicare Part D prescription drug plan. This can be a stand-alone plan that complements Medicare Part A and Part B coverage, or it can be part of a Part C Medicare Advantage managed care plan that rolls together hospital, medical, and prescription drug insurance.
