CDISNM Blog
Are you trying to decide between Medicare Advantage and Medicare Supplement (Medigap) plans? You’re not alone. This critical decision can significantly impact both your healthcare and your wallet. Let’s break down these options to help you make an informed choice.
The Fundamental Difference: You Can’t Have Both
First, understand this key point: you must choose between Medicare Advantage or Original Medicare with a Medigap plan. You cannot have both. Each option has distinct benefits and trade-offs that deserve careful consideration.
Medicare Advantage: The All-in-One Option
Pros:
- Lower monthly premiums (often $0)
- Extra benefits not covered by Original Medicare:
- Dental care
- Vision services
- Hearing aids
- Fitness memberships
- Built-in prescription drug coverage in most plans
- Annual out-of-pocket maximums
- Ability to have larger doctor networks – PPO
Cons:
- Limited to network providers HMO
- Requires referrals for specialists (in most cases)
- HMO
- Need pre-authorization for certain procedures
- May have limited coverage outside your home state
- Network restrictions might affect your choice of doctors
Original Medicare + Medigap: The Flexible Option
Pros:
- Freedom to see any doctor accepting Medicare nationwide
- No referrals needed for specialists
- No prior authorizations required
- Predictable costs
- Excellent coverage for frequent travelers
- Better for those with multiple state residences
- Little to no out of pocket expenses for doctors and hospitals
Cons:
- Higher monthly premiums
- Separate drug plan (Part D) needed
- Additional cost for supplemental benefits
- May have higher upfront costs
Making Your Decision: Key Factors to Consider
- Your Lifestyle
- Do you travel frequently?
- Do you split time between different states?
- How important is keeping your current doctors?
- Your Health Status
- Do you have chronic conditions requiring specialist care?
- How often do you see doctors?
- Do you anticipate major medical procedures?
- Your Budget
- Can you handle higher monthly premiums?
- Would you prefer lower monthly costs with potential copays?
- Have you considered total annual healthcare spending?
Important Timeline Tips
- Initial Enrollment: Sign up during your 7-month window (3 months before turning 65, your birth month, and 3 months after)
- Medigap Open Enrollment: 6 months from the first day of the month you turn 65 and enroll in Part B
- Annual Enrollment Period: October 15 – December 7 for plan changes
Making Your Final Choice
The “right” choice depends entirely on your personal circumstances. Consider:
- Reviewing all costs, not just premiums
- Checking provider networks in your area
- Evaluating your travel needs
- Assessing your health conditions
- Calculating potential out-of-pocket expenses
Need Help Deciding?
Our licensed Medicare specialists are here to help you navigate these choices. We’ll analyze your specific situation and help you choose the best coverage for your needs.
Contact us at (855) 740-2227 for a free Medicare consultation.
Remember: Your Medicare choices can significantly impact your healthcare experience and financial security. Take time to understand your options and make an informed decision.
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CDISNM Blog
During Medicare’s annual Open Enrollment Period, millions of seniors face crucial decisions about their healthcare coverage. While many believe Medicare automatically leads to reduced healthcare costs, the reality is often more complex. Here’s what you need to know to make informed choices about your coverage for 2025.
Key Dates to Remember
Mark your calendar: Medicare Open Enrollment runs from October 15 through December 7, 2024. These dates are critical for making changes to your coverage that will take effect on January 1, 2025.
- Review Your Coverage – Even if You’re Satisfied
Don’t skip your annual coverage review just because you’re happy with your current plan. Here’s why:
- Plan premiums and copays can change yearly
- New, more cost-effective options may be available
- Your health needs may have evolved
- Coverage terms and benefits often change annually
- Maximize Your Medicare Advantage Benefits
Medicare Advantage plans often include valuable extras that Original Medicare doesn’t cover:
- Dental care
- Vision services
- Hearing aids
- Fitness memberships
- Meal delivery services
If you’re not using these supplemental benefits, consider:
- Switching to a plan with benefits you’ll actually use
- Finding a lower-cost plan with fewer extras
- Exploring plans with specialized benefits that match your needs
Tips for a Successful Open Enrollment
- Begin researching options by mid-October
- Give yourself time to compare plans thoroughly
- Avoid last-minute rushed decisions
- Consider Your Healthcare Usage
- Review your current medical expenses
- List your regular prescriptions
- Think about any planned procedures for 2025
Compare Total Costs
- Monthly premiums
- Deductibles
- Copayments
- Drug costs
- Out-of-pocket maximums
Take Action Now
Don’t let the complexity of Medicare choices prevent you from potentially saving money and improving your coverage. Taking time to review your options during Open Enrollment could lead to significant healthcare savings in 2025 and ensure you have the coverage that best meets your needs.
Consider working with us, we are licensed Medicare agents who can help you compare plans and understand your options at no cost to you. Here’s some information about us.
Call us today at: (855) 740 – 2227
We are standing by to help for free.
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CDISNM Blog
Like most seniors, there’s a good chance you’ve heard of Medicare – you may even know that it’s a federally funded health insurance program. But if you’re not enrolled, you may not understand in detail the different parts of the program and how they work together to provide health insurance coverage. If you’re approaching the age of 65 and interested in learning more about Medicare Part A and Part B, here’s some information to get you started.
Medicare Part A
Medicare coverage is divided into several parts, which are differentiated by letters of the alphabet. Medicare Part A is one of the basics, providing hospitalization coverage, including hospital stay, skilled nursing facility care, home health care (skilled nursing, physical therapy), and hospice care. For most people, Medicare Part A is premium-free, meaning there is no charge for coverage as long as you meet a few basic eligibility requirements. Generally, as long as you are a permanent resident of the United States and you or a spouse paid Social Security taxes while employed, enrollment is automatic. While Medicare Part A is free, there are deductibles and co-insurance that you are responsible for paying.
Medicare Part B
Medicare Part B covers expenses that are medically necessary to treat or prevent a disease or condition. Other fees that occur outside of room and board while in the hospital- those related to diagnostic testing, preventative care, and the supplies needed to diagnose or treat medical conditions. Fees for visiting the doctor are also included in Medicare Part B. Medicare Part B pays 80 percent of approved charges. Part B is not premium-free. The standard Part B premium amount in 2024 is $174.70 (or higher depending on your income). However, most people who get Social Security benefits pay less than this amount. This is because the Part B premium increased more than the cost-of-living increase for Social Security benefits.
References:
www.medicare.gov
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CDISNM Blog
Medicare Supplement insurance (also called Medigap) offers seniors coverage for out-of-pocket expenses associated with Medicare like copays and coinsurance, and even deductibles. The right plan adds to Original Medicare coverage, giving you peace of mind and confidence that when you need medical care, you can get it – no questions asked.
Medicare Supplement
Medicare Supplement insurance is a supplement to Medicare Parts A and B, meaning you’re still in the Medicare program, but have coverage for expenses that Original Medicare does not cover, like traditional out-of-pocket costs many seniors struggle with. In New Mexico, there are five plans available each with slightly different benefits.
Eligibility Requirements
To join a plan, you must be enrolled in Medicare Part A and Part B. Medigap is a guaranteed issue, during your initial enrollment period, meaning even with medical complications, you cannot be turned down. Plus, if you continue to pay your premium on time, your Supplement plan is renewable, even if you develop health problems.
Choosing the Best Plan
Medicare Supplement plans in New Mexico are offered through private insurance companies. Plans are standardized, meaning a plan “A” offered from one company must provide the same minimum benefits as a plan “A” from another company. However, price does not need to be the same and there is great variance between companies on not only cost, but also, trustworthiness, dependability, and reputation. If you’re considering your options, be sure to consider reliability and affordability as important factors in choosing a provider.
References:
www.medicare.gov
www.bcbsnm.com
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CDISNM Blog
Medicare Advantage (MA or Part C), is a popular alternative to traditional Medicare. Since 2010, enrollment increased by 71 percent, with as many as one in every three eligible seniors today choosing a Medicare Advantage plan over Original Medicare. Understanding this option is a critical step in managing health care into retirement.
Medicare vs Medicare Advantage
Medicare coverage includes hospital insurance (Part A) and medical insurance (Part B). While Part A is free for most people, Part B carries a monthly premium. Prescription drug benefits (Part D) are not part of Original Medicare but can be added for an additional monthly premium. While a good percentage of costs are covered, seniors are responsible for out-of-pocket expenses, like deductibles, coinsurance, and copays. Part C is offered by private insurance companies as an alternative way to receiving Original Medicare. With an MA plan, you receive Part A and Part B benefits, as well as additional benefits not covered by traditional Medicare. Most plans include coverage for prescription drugs, as well as dental, vision, and in some cases, even hearing. Unlike Original Medicare, with Medicare Advantage, you are limited to doctors and hospitals that are part of a specified network. Networks can be large, or narrow depending on where you live and a referral may be needed to see a specialist.
Extra Benefits
While plans must cover all of the services offered through Part A and Part B (except hospice care), most offer more. Many provide comprehensive coverage—Part A, Part B, preventive dental, eye care, hearing assistance, wellness programs, and prescription drug coverage too. If you need new eyeglasses or simply want to explore your options with dentures, an MA plan may be the solution. Plus, plans always cover emergency and urgent care. They even offer emergency services outside of the plan’s service area (but not outside the U.S.). Medicare Advantage has grown significantly in the past few years, and now covers 31 percent of the 57 million people on Medicare. An easy way to secure Part A, Part B, and a few extra benefits. Part C is an all-in-one solution—hospital, medical, vision, dental, and prescription drug coverage.
Good Deal?
With comprehensive benefits and low premiums, Medicare Advantage sounds like a great deal. After all, putting together a similar plan using traditional Medicare would mean adding a prescription drug premium and maybe even Medigap to shoulder out-of-pocket costs. However, it’s important to look at your needs carefully to decide if Medicare Advantage makes sense for you.
Things to Consider
Network Availability Medicare Advantage may be a good option if the network includes providers you already use. Look carefully at which doctors are in the plan’s network, and whether or not you need a referral to see a specialist.
Out-of-pocket Expenses For those in good health who will don’t expect to visit the doctor’s office or hospital regularly, Medicare Advantage can be a great asset, offering additional benefits at a low cost. If, on the other hand, you will be visiting the doctor frequently and expect to have many copays, traditional Medicare supplemented with a Medigap plan can help with expenses.
The Bottom Line
Medicare Advantage is a great option for seniors looking for comprehensive care at an affordable price. As long as you can work within the network model, and won’t be needing a lot of specialized care, an MA plan may be a good deal.
References:
Medicare Advantage Stats: http://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/
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