Pay attention to what is really in Medicare plans

The Marion County Dept on Aging has received several calls about a television advertisement with a famous football player talking about new Medicare plans. This commercial is about Medicare Advantage plans.

So in hopes of clearing the muddy waters here are the key differences between Medicare with a supplemental plan and Medicare Advantage plan. A Medicare Supplement plan (Medigap policy) works with your Original Medicare Part A and Medicare Part B coverage – filling “gaps” in coverage. A Medicare Advantage plan administers your Medicare Part A and Medicare Part B benefits and must provide coverage at least as good as Original Medicare.

A Medicare Supplement continues from year-to-year and may raise premiums over time. A Medicare Advantage plan is only for a single calendar year and can change plan features and premiums each year – or the plan may not renew their plan contract.

Presently Marion County has three Medicare Advantage plan options to choose from. After your 6-month initial Medigap Open Enrollment Period with guaranteed issue rights, you can enroll in a Medicare Supplement at any time, but depending on where you live, you may be subject to medical underwriting, pay a higher premium, or have your enrollment denied based on your health. Medicare Advantage plans are guaranteed issue without any health questions (with the exception that you cannot suffer from End-Stage Renal Disease). Members of Medicare Advantage plans can also drop or change Medicare Advantage plans during the Medicare Advantage Open Enrollment Period (Oct 15-Dec 7)

Medicare Supplements do not have a fixed network of healthcare providers and in most cases, plan members can visit any healthcare provider that participates in Medicare.

Medigap policies are very portable for travelers – and may include some coverage for international travel.

Medicare Advantage plans often have a fixed network of doctors and hospitals with higher costs for people who are seeking benefits outside of a plan’s healthcare network. This office’s understanding is that the two local hospitals and physicians do not have a contract with Medicare Advantage plans. So you can use local medical services but you would pay out of network co-pay charges.

If you have any other questions about these options, please feel free to call the Marion Co Dept on Aging (620-382-3580).

Gayla Ratzlaff

Coordinator for Marion County Department on Aging

Hillsboro

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