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Pay Premiums Now or Out-of-Pocket Costs Later – What’s Your Strategy?

compare optionsMedicare’s Annual Enrollment Period is in full swing, and I have many individuals asking me which plan is best for them – a Medicare supplement plan or a Medicare Advantage plan. To be honest, the answer isn’t the same for everyone. There are numerous factors to consider before switching from a Medicare supplement plan to a Medicare Advantage plan or vice versa.

Comparing Premiums to Out-of-Pocket Costs

Medicare Advantage plans gain a lot of interest with their low or zero premiums, but it’s important to evaluate other out-of-pocket expenses before ruling out a Medicare supplement plan. Some Medicare Advantage plans work by having you pay a deductible and coinsurance, while others simply charge copays for various services.

Although the copay for a primary care physician may be somewhat low at $20 to $30 per visit, specialist copays can be as high as $50, and other services such as imaging, urgent/emergency care, or specialized treatments can run into the hundreds of dollars.

On the other hand, with most Medicare supplement plans, you simply pay a monthly premium, and your plan picks up any deductibles or coinsurance left behind by original Medicare. Here’s an example:

Rebecca is a 67-year-old female from Colorado has a Medicare Advantage plan and for the past few years has remained healthy – only seeing her physician maybe three or four times per year with a $25 copay.

Unfortunately Rebecca fell ill and was diagnosed with multiple sclerosis requiring ongoing medical care. Rebecca’s annual out-of-pocket expenses totalled over $5,000. As do Medicare supplement plans, her Medicare Advantage plan has an annual maximum out-of-pocket limit; however, the limit is $6,700 – so Rebecca is on the hook for the full $5,000 in out-of-pocket expenses.

Teresa, a 68-year-old female also from Colorado, found herself in a similar situation; however, Theresa has original Medicare combined with a Medicare supplement plan. Theresa pays $208 per month for plan F, which covers all of her out-of-pocket medical expenses. In one year, Teresa pays $2,496 in premiums, a substantial savings from the $5,000 in out-of-pocket expenses Rebecca must pay this year!

Choosing the Plan that is Best for You – Pay Now or Pay Later

Rebecca’s example is extreme, but certainly a factor to consider when deciding whether to go with a Medicare Advantage plan or Medicare supplement plan. Without a sudden chronic or terminal illness, it’s likely that a Medicare Advantage plan can provide an abundance of coverage without the need for monthly premiums – you simply “pay as you go.”

If you fear, however, that the chance might come up that this route could become too costly and prefer the protection of paying a premium up front to cover any future possibilities, a Medicare supplement plan may be in order. Your MediGap Advisors’ Personal Advisor can guide you in the right direction and help you choose the plan that is best for you!

Do you have any questions about Medicare Advantage Plans or Medicare supplement plans? Do you have questions about Medicare’s Annual Enrollment Period? We would like to hear from you!

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.

 

 
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