The biggest factor at the moment truly depends on where you live, and other factors involved include what type of insurance your doctors accept. Depending on where you live, Washington and Oregon doctors will not accept patients when Medicare is their primary care, and they only take new patients if you are on one of the in-network Medicare advantage plans. Conversely, in some areas having Medicare as your primary payor is better.
Here are some things you need to know about Medigap and Medicare Advantage:
- The benefits of Medigap plans offered in Washington and Oregon are standardized by the federal government. This means that plans sold by different insurance companies all offer the same benefits. No company is any different with a high deductible plan F than another company with a high deductible Plan F; the difference will only be in each company’s premium.
- Depending on where you live and how your state regulates premium is a factor also. Some states have a “community rating”, which means it doesn’t matter if you’re 65 or 75; all ages pay the same premium. Other states have what they call “age banded premiums”, so in this case a 65 year old will have lower premiums than that of a 75 year old due to age. Also, some states have” male/female rates” and “smoker-nonsmoker” rates.
- Medicare Advantage plans are not age banded, and could be considered community rated at this point. Factors like age, gender type, smoker, or non-smoker don’t seem to be considered, as the premium is the same for all.
- Medigap plans do not have any type of network of doctors; you can see any provider that would accept you having Medicare as your primary payor.
- Medicare Advantage plans offer something similar to having Medicare plus a supplemental policy which would be a Preferred Provider Organization (PPO). This means you can have access to any doctor as long as they will accept the plan. The difference would be if they are considered an” in-network provider”, or “out-of-network provider”. In most cases, going out-of-network could generate higher co-pays than staying within the network. Also, Medicare Advantage plans have HMOs, where you must remain in-network except for urgent or emergency medical services.
- The premiums for Medicare Advantage plans range in price and are often lower than that of a supplemental policy (gap policy). I see premiums from a monthly premium of zero and up.
- If you purchase a Gap policy you also need to look at picking up a Medicare Part D benefit for having access to drug coverage. With Medicare Advantage, most plans include the Part D within their core benefits. Putting Part D in place is totally voluntary; however you could be subject to penalty without putting a drug benefit in place.
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