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Medicare Advantage vs Original Medicare

Original Medicare is administered by the federal government and covers Part A (inpatient) and Part B (outpatient). Original Medicare has no out of pocket limit. This is the main reason people enroll in Medicare Advantage or a Medicare supplement.

Medicare Advantage, also known as Medicare Part C launched in 1997 is administered by insurance companies and is regulated by the federal government and covers Part A (inpatient) and Part B (outpatient).

Medicare Advantage plans may also include Medicare Part D (prescription drug coverage) in addition to Part A and Part B. Some plans may cover additional services such as vision, hearing and dental.

Medicare Supplement Insurance

 

Medicare Supplement insurance, also known as Medigap or MedSup is offered through insurance companies and may cover costs such as Medicare coinsurance, copayments and deductibles. These plans do not cover prescription drug coverage. One may purchase a stand alone Part D coverage along with plan.

With Medicare supplements the plan is exactly the same no matter which company you go with. So, when choosing a plan you’ll want the plan the prices out the lowest from whichever insurance company. Plan F & G has the strongest coverage of all the plans with Plan F being the most popular. We recommend Plan G.

The only difference between Plan G & F

  • Plan F pays the $185 Part B deductible
  • Plan G’s annual savings

Medicare supplements can increase their premium at any time, so it makes sense to get your supplement as soon as possible and lock in at a lower monthly premium. You may submit your application 3 months prior to the month you turn 65.

Medicare (Coverage Summary)

 

Description OFFERED BY MEDICARE DEDUCTIBLE Deductible
Part A hospitalization in patient standard $1,364
Part B medical expenses in or out patient services, equipment and supplies standard $185
Part C Medicare Advantage (I won’t place my clients in this plan) no (private companies only)
Part D prescriptions generic, brand and non-formulary optional $415

 

What Medicare Does Not Cover

  • Assistance with bathing, dressing, using the bathroom or any other nonmedical home health care needs
  • Television, phone, slippers etc. (hospital stay)
  • 24 Hour Nurse Line
  • Final Expense
  • Dental
  • Vision
  • Hearing
  • Medical Alert
  • Long term care

What You Pay

Part A

HOSPITALIZATION SKILLED NURSING FACITY CARE
Days Cost Days Cost
1-60 $1,364 (deductible) 1-20 $0
61-90 $341 a day 21-100 $170.50
91+ $682 a day 100+ 100%

Part B

Services, equipment and supplies $185 Plus 20% (no maximum out of pocket)
Blood First 3 pints 0%, then 100% of the next $183, then 20% of the remainder
Home Health Care $0

Part D

  • First your $415 deductible
  • Then coinsurance until both Medicare and patient has paid out $3,700
  • Then you pay 100% until you have paid $4,950 (your maximum out of pocket)
  • Then you pay $0 (till the calendar year ends and the paying cycle starts all over again)

Basic Supplement Plans

A B C D F G
Basic, Including 100% Part B coinsurance Basic, Including 100% Part B coinsurance Basic, Including 100% Part B coinsurance Basic, Including 100% Part B coinsurance Basic, Including 100% Part B coinsurance Basic, Including 100% Part B coinsurance
Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance
Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible
Part B Deductible Part B Deductible
Part B Excess (100%) Part B Excess (100%)
Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency

K L M N
Hospitalization and preventative care paid at 100%; other basic benefits paid at 50% Hospitalization and preventative care paid at 100%; other basic benefits paid at 75% Basic, Including 100% part B coinsurance Basic, Including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER
50% Skilled nursing facility coinsurance 75% Skilled nursing facility coinsurance Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance
50% Part A Deductible 75% Part A Deductible 50% Part A Deductible Part A Deductible
Foreign Travel Emergency Foreign Travel Emergency
Out-of-pocket limit $5,120; paid at 100% after limit reached Out-of-pocket limit $2,560; paid at 100% after limit reached

Shield stethoscope medical concept

Disclaimer: Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Plans are not available in all areas and may be subject to underwriting; terms and conditions may apply.