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Category: Medicare Supplement

Why do some seniors choose Medigap over Medicare Advantage?

Andy |
Medigap
Medigap offers the type of flexibility that some seniors may find is worth the higher price tag.

As Medicare open enrollment kicks into high gear, millions of older adults are taking a fresh look at their health insurance options. For many, that means deciding between sticking with or switching to either a Medicare Advantage plan or a Medicare supplemental insurance policy, also known as Medigap. It’s a choice that can shape not just monthly budgets but also how easily seniors can access the care they need.

At first glance, Medicare Advantage plans may seem like the obvious choice. Many offer low or $0 monthly premiums and bundle extra perks like dental, vision and hearing coverage. For retirees living on fixed incomes, those features can be appealing. But despite the popularity of Medicare Advantage — 54% of all Medicare beneficiaries are enrolled in these plans — a significant share of seniors continue to rely on Medigap coverage instead.

So what drives some seniors to choose Medigap coverage over Medicare Advantage plans? That answer typically comes down to what people value in their healthcare coverage. Below, we’ll break down what to consider.

Why do some seniors choose Medigap over Medicare Advantage?

Medigap plans work alongside Original Medicare, covering many of the out-of-pocket costs that traditional Medicare doesn’t, like deductibles, coinsurance and copayments. Medicare Advantage plans, on the other hand, replace Original Medicare with a private insurance plan that often comes with its own rules, networks and cost structures. Here’s more on why many older adults opt for Medicare supplemental coverage over Medicare Advantage plans:

Access to a wider network of doctors and hospitals

One of the main reasons seniors opt for Medicare supplemental coverage is the flexibility to see any doctor or specialist who accepts Medicare, anywhere in the nation. There are no restrictive provider networks or referral requirements. For retirees who travel frequently, live in multiple states or simply want to keep their existing doctors, this nationwide access can be a major advantage.

Find out how Medigap can help fill in your Original Medicare coverage gaps today.

More predictable costs over time

While Medigap plans typically have higher monthly premiums than Medicare Advantage plans, they tend to offer more stable and predictable out-of-pocket expenses. Depending on the plan type, like Plan G or Plan N, Medigap may cover nearly all of the costs left over after Medicare pays its share. For seniors managing chronic conditions or anticipating regular medical visits, that type of coverage predictability can be invaluable.

Fewer administrative hurdles 

Medicare Advantage plans often require beneficiaries to obtain prior authorizations before they can be approved for certain treatments or services, and these hurdles can sometimes lead to delays or denials for otherwise necessary medical care. Medigap paired with Original Medicare typically doesn’t have these barriers, though, which makes it easier to access care when you need it.

Stable benefits year after year 

While Medicare Advantage plans can change their provider networks, cost-sharing rules and benefits annually, Medicare supplemental plans are standardized and don’t change once you enroll. That type of stability can make long-term financial planning simpler and reduce the risk of unexpected coverage shifts.

How to decide between Medicare supplemental coverage and Medicare Advantage

Both Medicare Advantage and Medigap have clear benefits and tradeoffs and the right choice often depends on your health needs, financial situation and lifestyle. Here’s what to weigh as you’re deciding which coverage option makes the most sense for your needs:

Consider your healthcare usage 

If you visit doctors frequently, need specialist care or expect ongoing medical costs, Medigap’s more comprehensive coverage may make sense. On the other hand, if you’re relatively healthy and want to minimize monthly premiums, a Medicare Advantage plan could be more cost-effective.

Think about where you receive care 

Seniors who split time between states or travel often may benefit more from Medigap’s nationwide coverage. But if your care is primarily local and your providers are in-network, Medicare Advantage could work well.

Weigh long-term costs carefully 

While Medigap premiums can rise with age, Medicare Advantage plans can also change cost structures each year. Some seniors start with Advantage plans for the lower premiums and switch to Medigap later. However, in many states, switching to Medigap after your initial enrollment period may require medical underwriting, and you could be denied coverage or face higher premiums if your health has changed.

Factor in extra benefits 

Medicare Advantage plans often offer extras like dental, vision, fitness memberships or transportation services. If these are important to you, they might tilt the balance toward Medicare Advantage. Medigap focuses primarily on covering medical costs rather than additional perks.

The bottom line

When choosing between Medicare Advantage and Medigap, there’s no universal answer for retirees. Medigap appeals to many seniors because of its flexibility, predictable costs and stable coverage, while Medicare Advantage can be more affordable for those with limited healthcare needs or who value additional benefits.

When weighing your options during open enrollment, be sure to assess your health, budget and lifestyle carefully. By understanding the potential benefits and downsides of each option, you can select the coverage that best fits your unique situation and ensures you have the care you need at a cost you can manage.

Would you like more information on a Medigap plan?

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Andy Orlikoff

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Should You Ditch Your Medicare Advantage Plan? Most People Do

Andy |

If you’re tempted to ditch your Medicare Advantage plan, you’re not alone. Here’s when it’s a good idea and how to go about it.

BY

A young female medical doctor is meeting with a senior female patient. She is smiling as she is looking at her patient.

Medicare coverage doesn’t just mean signing up for government insurance. In fact, more than half of Medicare recipients now get their coverage through a Medicare Advantage plan, or Medicare Part C plan, which is offered by a private insurer.

Advantage plans are an alternative to original Medicare, replacing Part A (hospital coverage), Part B (outpatient care coverage), and sometimes Part D (prescription drug coverage).

Enrollment in these plans is expected to grow to 60% of the eligible population by 2030, with many people drawn to them because they’re often marketed as “zero premium” plans with out-of-pocket limits, while Medicare Part B has uncapped spending and charges premiums. The Trump administration strongly favors the expansion of Medicare Advantage plans.

Yet, while Advantage Plans seem like a good alternative, a substantial number of older Americans who sign up for them don’t stick with them. In fact, among those who signed up between 2011 and 2022, around half left their plans within five years.

Recent research published in the journal Health Affairs helps demonstrate why so many are opting out of their Advantage Plan during open enrollment, either by switching to a different Part C plan or by returning to traditional Medicare instead. Since these Advantage plans are less likely to attract beneficiaries over the long term, the study warns that such plans will likely have less incentive to cater to participants with chronic conditions.

Should you ditch your Medicare Advantage plan? Why others are

Researchers sought to gain insight into why Medicare Advantage participants were disenrolling by using information from the Medicare Current Beneficiary Survey, linked with data on Medicare Advantage enrollment. The survey measures patient satisfaction with access to medical care, as well as the cost and quality of the care they receive.

Researchers found two primary factors drove departures from Medicare Advantage plans, and neither was related to cost. Instead, most people who disenrolled did so because of difficulty accessing care as well as concerns about the quality of their care.

Access issues, in particular, were especially likely to prompt Advantage customers not just to switch to a different Medicare Part C plan but instead to return to traditional Medicare. This makes sense, given that traditional Medicare doesn’t impose the same limits as Advantage Plans on which doctors or care providers patients can visit.

Hospitals have also been ending their affiliations with Medicare Advantage Plans, creating huge problems when break-ups happen outside of the open enrollment period, and Advantage Plan customers suddenly find themselves without coverage at the hospital where they’d been treated.

Researchers also revealed that individuals with health issues were more likely to switch out of their Medicare Advantage plan. Those who described themselves as being in poor health were:

  • More than twice as likely as other Advantage members to express difficulty with getting care;
  • More than three times as likely to be dissatisfied with the quality of care they are getting
  • More than twice as likely to be unhappy with the cost of their care
  • More than twice as likely to be dissatisfied with their specialty care.

“People who stay in [Medicare Advantage} are shopping for better service, but … those who switch to traditional Medicare are the ones potentially with high health care needs, who are much more strongly driven by dissatisfaction with access to care issues ” said Geoffrey Hoffman, Ph.D., Associate Professor, U-M School of Nursing and one of the study’s authors.

This tendency to switch between Advantage plans or back to original Medicare could undermine the long-term effectiveness of these plans while also driving up the nation’s cost to provide original Medicare. The study warns that Advantage plans will likely focus on the short-term healthcare needs of beneficiaries due to plan hopping.

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Medicare Supplement Part G vs. Medicare Advantage: What You Need to Know Before Choosing

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As you approach the age of 65, understanding the various Medicare options available to you can feel overwhelming. Two of the most popular choices—Medicare Supplement Part G and Medicare Advantage plans—often cause confusion among beneficiaries. While both plans aim to fill gaps in Original Medicare, they are vastly different in terms of coverage, cost, and flexibility. This comprehensive guide will help you understand Medigap Part G and Medicare Advantage options, making it easier to choose the right plan based on your healthcare needs.

Understanding Medicare Supplement Part G

What is Medicare Supplement Part G?

Medicare Supplement Part G, often referred to as Medigap Part G, is a private insurance plan that works alongside Original Medicare (Parts A and B) to cover “gaps” in Medicare. These gaps include out-of-pocket expenses such as copayments, coinsurance, and deductibles that Medicare doesn’t cover. Essentially, Part G helps reduce the financial burden of medical costs by supplementing Original Medicare’s limitations.

What Does Part G Cover?

Medicare Supplement Part G offers comprehensive coverage, second only to the now-unavailable Medicare Supplement Plan F. It covers:

The only thing Part G doesn’t cover is the Medicare Part B deductible, which as of 2024 is $226 annually. Otherwise, it covers nearly all out-of-pocket costs for Medicare-approved services.

Pros of Medicare Supplement Part G

  1. Comprehensive Coverage: You pay very little out of pocket beyond your monthly premiums, providing peace of mind when facing high medical expenses.
  2. No Network Restrictions: Medigap Part G allows you to see any doctor or specialist nationwide who accepts Medicare, offering greater flexibility.
  3. Predictable Costs: With Part G, you can anticipate your healthcare costs, knowing that you’ll be covered for most of the expenses not included in Original Medicare.

Cons of Medicare Supplement Part G

  1. Higher Premiums: Medigap Part G tends to have higher monthly premiums compared to other Medigap plans and Medicare Advantage options.
  2. Does Not Include Drug Coverage: Part G does not cover prescription drugs, so you’ll need to purchase a Medicare Part D plan separately for drug coverage.
  3. No Extra Perks: Unlike some Medicare Advantage plans, Medigap Part G doesn’t offer additional benefits like vision, dental, or hearing care.

What is Medicare Advantage?

How Does Medicare Advantage Work?

Medicare Advantage plans (also known as Medicare Part C) are an all-in-one alternative to Original Medicare, offered by private insurers. These plans must provide at least the same level of coverage as Original Medicare but often include additional benefits like prescription drug coverage, vision, dental, and hearing care. Medicare Advantage plans bundle Medicare Part A, Part B, and sometimes Part D into a single plan, offering beneficiaries convenience and potentially lower overall costs.

Types of Medicare Advantage Plans

There are several types of Medicare Advantage plans, including:

Pros of Medicare Advantage Plans

  1. Lower Monthly Premiums: Many Medicare Advantage plans have low or even $0 monthly premiums, making them an attractive option for cost-conscious beneficiaries.
  2. All-in-One Coverage: These plans often include prescription drug coverage (Part D) and additional benefits like vision, dental, and hearing care.
  3. Additional Benefits: Medicare Advantage plans may offer extras such as gym memberships, wellness programs, and telehealth services.

Cons of Medicare Advantage Plans

  1. Network Restrictions: Most Medicare Advantage plans have network limitations, requiring you to use specific doctors and hospitals. You may need referrals to see specialists.
  2. Variable Costs: While premiums may be low, out-of-pocket costs can vary greatly, especially if you need care outside of your plan’s network.
  3. Limited Nationwide Coverage: Unlike Medigap Part G, Medicare Advantage plans may not provide the same level of nationwide coverage, making them less suitable for frequent travelers.

Medicare Supplement Part G vs. Medicare Advantage: A Direct Comparison

Now that we’ve reviewed the basics of both Medigap Part G and Medicare Advantage, let’s dive into a side-by-side comparison to highlight their key differences.

1. Coverage Options

2. Cost

3. Flexibility

4. Prescription Drug Coverage

5. Additional Benefits

Which Plan is Right for You?

When choosing between Medicare Supplement Part G and Medicare Advantage plans, your decision will largely depend on your personal healthcare needs and lifestyle.

Choose Medigap Part G if:

Choose Medicare Advantage if:

Conclusion

Choosing between Medicare Supplement Part G and Medicare Advantage plans is a critical decision that can impact your healthcare and financial well-being. Each plan offers unique benefits, with Medigap Part G providing comprehensive coverage and flexibility, while Medicare Advantage plans are more affordable and offer additional benefits. Understanding the key differences and considering your personal healthcare needs will ensure that you select the right Medicare coverage option that works best for you.

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At American Insurance Benefits, we’re passionate about helping individuals and families in Arizona secure the health insurance coverage they need at a price they can afford. Since 2004, Andy Orlikoff and our team have been dedicated to making the process of finding the right plan as simple and stress-free as possible. If you’re looking for expert guidance tailored to your unique needs and budget, don’t hesitate to reach out to us today. Let’s find the perfect health insurance solution together.

The big decision: Should I stay with original Medicare or choose a Medicare Advantage plan? Here’s why one expert says 1 of those options is the clear worse choice for seniors

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As you approach age 65, you’ll have some decisions to make about medical coverage. On one hand, you can enroll in Medicare. But you may be tempted to choose another option instead: a Medicare Advantage (MA) plan instead. If you’ve seen the advertisements for MA plans, you might think they’re more cost-effective and comprehensive than Medicare. But according to Keith Armbrecht, Founder of Medicare education company, Medicare on Video, that’s not necessarily true.

“I would never choose a Medicare advantage plan,” he says in a YouTube video entitled “Why Medicare Advantage Is The Worst Choice For Seniors.”

Here’s why he’s not a fan of these plans.

What is a Medicare Advantage plan?

Medicare Advantage plans are alternative insurance plans to Medicare, and they’re offered by Medicare-approved private companies. These plans are sometimes called “Part C” or “MA,” and they include Medicare Part A (hospital insurance) and Part B (medical insurance).

Those interested in MA have more than 40 different plans to choose from. The main
reasons to explore them include:

That being said, there are a few downsides to Medicare Advantage plans. Here are some important things to consider before locking into an MA plan.

Limited choice

If you opt for an MA plan, your choice of doctors can be limited and you’re likely to face obstacles in getting approved for procedures or seeing specialists. “The primary reason I would absolutely choose original Medicare and would never choose Medicare Advantage is because I want control over what I do,” says Armbrecht. With an MA plan, he warns, you can face wait times of “weeks, even months,” to get referrals or have procedures authorized.

You’re typically limited to doctors in the plan network and service area, as well,
according to the government’s Medicare website.

Deceptive marketing

The Medicare Advantage plan industry has a history of deceptive practices. In 2022, the Majority Staff of the U.S. Senate Committee on Finance found that Medicare beneficiaries were being inundated with aggressive marketing tactics, false and misleading information and overall predatory marketing from MA providers. According to the report, deceptive Medicare Advantage marketing practices are, “widespread, not isolated events.”

According to a 2022 review from the New York Times, four out of five of the largest MA providers (UnitedHealth, Humana, Elevance and Kaiser) have faced federal lawsuits for fraud and at least eight providers overbilled, according to the U.S. Department of Health and Human Services Office of the Inspector General.

Denied claims

Multiple studies have shown MA plans have a pattern of denying claims that should be covered.

A 2022 review from the Inspector General’s office found that MAs denied 13% of prior authorization requests that met Medicare coverage rules. Essentially, these claims would have been approved under original Medicare. The most commonly denied requests were imaging services, stays in post-acute facilities and injections.

Go to the source

“Medicare is probably the only government program that does exactly what it’s supposed to do and does it very well,” says Armbrecht. In other words, original Medicare is likely your best choice. If you’re nearing 65 and considering your options, you can visit Medicare.Gov for accurate and up-to-date information so you can make the right decision for your health insurance needs.

10 little-known Medicare benefits you could easily miss out on

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Medicare’s basic, original Part A (hospital insurance) and Part B (medical insurance) cover obvious things you expect from health insurance: hospital stays, appointments with your doctor when you’re sick, ambulance services, flu shots. But the government’s healthcare program for Americans 65 or older also pays for many things that might surprise you.

If you’re on Medicare or are approaching that time of your life, you’ll want to be aware of these 10 Medicare benefits that enrollees often don’t know about and that can keep you from dipping into your savings.

1. Annual ‘Wellness Visits’

Once you’ve had Medicare Part B coverage for a year, you’ll get what’s called an annual wellness visit with your doctor, who will take routine measurements, such as your height, weight, and blood pressure, and review your medical history. You’ll fill out a “Health Risk Assessment” questionnaire to identify risk factors — so you and your doctor can work on keeping you healthy. Medicare says the appointments also can include “detection of any cognitive impairment.” That means your physician will be on alert for signs of Alzheimer’s or similar ailments.

2. Obesity Counseling

Obesity causes many illnesses and can make frail older bodies much weaker. Diabetes and heart disease rates skyrocket for those who are overweight or obese. Joint and bone diseases are easier to manage at healthy weight levels. If you have a Body Mass Index (BMI) reading of 30 or more, Medicare will cover face-to-face counseling sessions in a primary care setting (like a doctor’s office) to help you bring your weight down to a healthier level.

3. Help to Quit Smoking

If you’re a smoker, Medicare can help you kick the habit. Letting go can be tough, especially if you’ve been a lifetime smoker. To help you break your nicotine addiction, Medicare will pay for eight in-person counseling sessions per year. But note that Medicare’s drug coverage will not pay for stop-smoking products sold over the counter at drugstores, like nicotine patches, lozenges, and gum.

4. Some Hearing Exams

Basic Medicare usually won’t pay for hearing aids or routine hearing tests. But it may cover a hearing exam if your doctor says it’s medically necessary. Hearing is related to balance. When a senior is having balance issues, a physician may want to check the ears to see if there’s an inner ear problem requiring medical treatment.

5. Hospice Care

Hospice care comprises a host of treatments at the end of a person’s life. Medicare will pay for a long list of hospice services, including nursing care, and grief and loss counseling for the patient and family. Hospice coverage applies when a Medicare recipient has been given six months or less to live and has agreed to forgo further attempts at a cure. Medicare-certified hospice care usually takes place where you already live — whether that be at home or in a nursing home. You can also receive hospice care in an inpatient facility. However, it’s important to note Medicare doesn’t cover your room and board, though it may pay for a short-term stay at a hospice facility if your hospice team determines you need that. If you’re dealing with any other health issues not related to your terminal illness, that should also still be covered by Medicare. But the government’s Medicare site points out that’s fairly unusual. Once you select hospice care, the hospice benefit typically covers everything you need.

6. Counseling for Alcohol Problems

Much like smoking, alcohol abuse can have seriously negative effects on the wellness of an older person. Medicare provides alcohol misuse screening and treatment free of charge. It covers one screening per year and up to four brief counseling sessions if the reviewing physician believes a patient needs help.

7. Disease Screenings

Medicare covers screenings for numerous diseases as part of its preventive services. Medicare will pay for testing to detect HIV and other STDs, diabetes, glaucoma, breast and cervical cancer, colon and prostate cancer, and heart disease. Patients with histories of smoking can get an annual lung cancer screening, and Medicare also covers annual screenings for depression and other behavioral health issues that are a concern for seniors.

8. Special Footwear for Diabetes

One of the least-known Medicare benefits is its allowance for specialized shoes for people with diabetes. The disease can cause poor or abnormal circulation in the feet, and a lack of proper treatment can result in the need for amputation. Another risk is diabetic neuropathy, which can damage nerve endings in the feet. Diabetic footwear helps regulate circulation and reduce the danger of neuropathy. Medicare will pay for one pair of custom-molded shoes and inserts and a pair of extra-depth shoes if they’re prescribed and provided by a podiatrist or other qualified health professional. Your insurance will also cover another two pairs of inserts for your custom-molded shoes and three pairs of inserts for extra-depth shoes each calendar year.

9. Wheelchairs and Scooters

Wheelchairs and mobility scooters are important tools to help those with debilitating conditions lead normal lives. Medicare will pick up the cost under certain circumstances. The wheelchair or scooter must be considered medically necessary. Your doctor would need to certify that you are unable to walk without difficulty. The physician would be required to write a prescription for the vehicle or wheelchair after giving you an exam.

10. A Walk-In Bathtub (Maybe)

A walk-in tub can help those with joint problems or other issues that make climbing into a traditional bathtub difficult or impossible. Medicare may help with the cost of a walk-in tub, even though the tubs are not on the list of “durable medical equipment” that Medicare will cover, including wheelchairs, oxygen equipment, and hospital beds. In order for you to obtain coverage, your doctor would have to attest that a walk-in tub is an absolute medical necessity. Medicare wouldn’t provide assistance upfront — after you buy the tub, you’d submit the bill for possible reimbursement. But there’s no guarantee that you’ll get your money back.