David, 86, had to pay for a colon cancer screening and his friend did not. His family thought David was covered by Medicare but when he called the insurance company, they said Medicare Advantage was different than Medicare and he owed the money. They gave me a call and I explained the situation to them.
Senior health plans called Medicare Supplemental Insurance or Medigap plans have 10 different plans all standardized by the Federal Government. Plan “A” will have the same benefits with Mutual of Omaha as Plan “A” with Humana. Plan “F” is the senior health plan that covers all the “gaps” in Medicare. It pays the
20% Part A deductible. It also pays 100% of the Part B co-insurance. Medicare Supplemental Insurance have a higher monthly premium than Medicare Advantage plans. You also have to buy a separate policy for Medicare Part D prescription coverage.
Senior health plans called Medicare Advantage are different. They are offered by private insurance carriers and they take the part of Medicare in paying the bills thus the insured is removed from Medicare. All the plans have similar but different benefits.
Some offer gym, vision and hearing discounts and some do not. The main difference though is that the insured will have a maximum out of pocket to pay. The Blue Cross/Blue Shield of Florida Medicare Advantage PPO, for example, has a $4500 maximum out of pocket cap. If and when you are a dmitted to a hospital you will pay $300 per day for the first 5 days. You will also pay doctor and urgent care co-pays. The premiums are also very low on the Medicare Advantage plans . In Florida you can get a PPO plan for $63 per month and in the counties where the HMO is available, the premium is $0. Medicare Advantage plans also include Part D prescription coverage. Here is another point to clear up. David’s Medical Insurance plan told him he owed the money for a colonoscopy. Blue Cross Medicare Advantage covers colonoscopies at no charge. When deciding on which carrier to pick for coverage it is always a good idea to use an insurance broker. Our services are free and we can explain all the details to you that you might miss.
Its really a personal decision about which plan to pick. Money wise Medicare Supplemental Insurance Plan F which covers all the gaps and is the most expensive + a Part D plan for prescriptions will cost a lot more than Medicare Advantage PPO or Medicare Advantage HMO on a monthly basis. But, and this is a big but, if you require hospitalization don’t forget the co-insurance you will have to pay. Usually when you add the two plans up on a yearly basis and add the co-insurance to the Advantage plans you will save a couple hundred dollars a year with the advantage plans. When trying to decide what to do, please give us a call at Insurance Medics. We would be happy to go over your options with you.
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