Finding A Medicare Plan That Works

Two main options are available when it comes to covering expenses not taken care of by Medicare. Medicare advantage plans and medicare medigap plans. Because there is a lot of confusion between the two I would like to address the main differences. Typically there are always exceptions to any rule so please check with your qualified representative to insure your best plan choice.

Medicare advantage plans usually have premiums that are lower that medicare supplement plans. Additionally, prescription drug coverage is usually included in the plan. A medicare advantage plan is typically set up as an HMO which means you have to choose your primary care physician. If you need to go to a specialist a referral would be required. When care is provided on this type of plan there is usually a copay that needs to accompany the visit. Plans changes can only be done on these plans during open enrollment periods.

There are some medicare advantage plans that do provide a greater degree of flexibility in choosing doctors. Those types of plans would be considered PFFS or PPO plans. Both of these plans usually require a monthly premium.

Medicare supplement options work differently than medicare advantage plans. On a medicare supplement plan Medicare is your primary insurer and the medigap plan is what is called your secondary insurance. There are several types of medicare supplement plans. For explanation purposes I will concentrate on plan F.
On a medicare supplement plan you are not limited to having to have a primary care physician. You can go to any doctor (primary or specialist) that accepts medicare. This includes out of state coverage.

If medicare is your primary insurance you will need a part D (prescription drug plan) that will have to be purchased separately. The average cost of a plan D is $30.00 per month.
Changes on a medicare supplement plan may be made at anytime. However the company that you are switching to may require underwriting.
A medicare supplement plan F would take care of doctors office visits so no copay would be necessary. Additionally, there would be no hospital copay or deductible.

Because of the enhanced benefits there is a monthly premium required for medigap plans.
By providing details on the different available options my hope is that you can make an informed decision.


About The Author

Scott Kerby is President of Vertex Insurance which specializes in providing programs and resources for elderly care. Please visit our website at: and

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