Medicare Plans?

 This is a quick review of some of the considerations when selecting Medicare plans.  At various Medicare plan selection websites or other Medicare information communications, I have observed Medicare plans being either differentiated between: 

a) Medicare Part G or N vs. Medicare Advantage; or

b) Medicare Gap vs. Medicare Advantage; or

c) Medicare Supplemental plans vs. Medicare Advantage. 

As you can anticipate, Medicare Part G or N, Medicare Gap, and Medicare Supplemental plans must be somewhat synonyms or closely related. All of these typically are plans that are attached to supplement Medicare's basic primary health care coverage.  That is certainly the case for Part G or N.  The latter two are identical except that Part G typically charges no copay for primary care office visits, meanwhile Part N does charge a small copay in exchange for lower premium.  

All these mentioned plans (Medicare Part G or N, Medicare Gap, and Medicare Supplemental plans), I think do not include any dental, vision, and drug coverage.  You typically buy this additional coverage separately.  Going forward, I will call all these plans the disaggregated plans. 

Medicare Advantage plans pretty much stand alone in their category.  They actually package and include all coverage into one single insurance plan (including, dental, vision, drug).  We could call it an aggregated plan vs. the disaggregated plans, but I will simply keep their current name Medicare Advantage.  

Medicare Advantage has numerous huge advantages.  They are far cheaper.  They often charge no premium at all, and they include the other mentioned coverage (dental, vision, drug).  The disaggregated plans will often cost you $100 or more per month for the supplemental health coverage alone.  When you include the additional coverage (vision, drug, dental), you may well have total monthly premiums of $200 or more. 

However, there are a couple of considerations to watch out for with Medicare Advantage plans.  

The first one is that the additional coverage included in Medicare Advantage is most often really minimal.  It is both minimal in coverage amount and minimal in access.  I personally have a Medicare Advantage plan, and the dental insurance component did not include a single dentist in the town were I live.  We have about 10 of them.  I did not have access to a single one.  As a result, I ended up buying a separate dental insurance just as if I had bought a Medicare disaggregated plan to begin with.  Similarly, the drug coverage was really poor.  So, I ended up getting a free Easy Drug Card at easydrugcard.com, where I could get drugs at a much cheaper price than on my Medicare Advantage drug coverage. 

The second consideration is that a Medicare Advantage plan is truly different than Medicare.  

With a Medicare disaggregated plan, Medicare is the primary insurer.  And, whatever private insurance you have (Aetna, Blue Cross, United Healthcare) acts as the secondary insurer.  What that means is that whether any provider is within network or not of the secondary insurer, you can still use Medicare and typically get 80% coverage at any provider. 

The above is not true for Medicare Advantage.  Such plans are whereby Medicare has contracted with a private insurer to pretty much outsource the entire administration of healthcare coverage.  In such a case, the private insurer is the primary insurer, and Medicare the secondary.  What that means is that the private insurer network entirely controls your access to providers whether they accept Medicare or not.  I learned this the hard way.  I suffered a severe bike accident recently.  And, I needed physical therapy.  Within our town we are blessed with an abundance of excellent physical therapist offices with top Yelp reviews.  They all accepted Medicare on a stand alone basis.  So, I could have had access to those with at least an 80% coverage with any Medicare disaggregated plan.  But, I did not have access to any of the top ones with my Medicare Advantage plan.  With the latter, I had only access to a single PT office that had really pretty low ratings.  This was because the PT place was not "in network" of my primary insurer.  

Overall, am I upset with my Medicare Advantage plan?  No, not really.  I would even say that it is really good.  Even when I factor that I had to purchase dental insurance, my total monthly premium (on top of Medicare) is far lower than it would be with any Medicare disaggregated plan alternative.  My limited to access to PT place was definitely an impediment.  But, this PT place is actually pretty good.  Their lower Yelp ratings were due to billing issues, that are often not that difficult to resolve.