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Medicare vs. Medigap: What Seniors Need to Know

  • By William Bryant
  • 24 Mar, 2017

Understanding What's Covered

Medicare vs. Medigap: What Seniors Need to Know

Understanding exactly what's covered under your Medicare plan is difficult enough, but once you add your Medicare Supplement plan options into the mix, you may feel completely overwhelmed. Each policy holder's circumstances will be different, but S2S Silver Services can help you find the Medicare Supplement plans in Virginia that best suit your needs. To help start you off, we've put together a brief guide explaining what seniors need to know about their Medicare and Medicare Supplement plans.

What Does Medicare Cover?

Medicare itself is made up of four different parts:

  • Medicare Part A -- This is geared towards hospital coverage. In most cases, it will cover most hospital care deemed medically necessary, as well as care at skilled nursing facilities, hospice facilities, and home health care.
  • Medicare Part B -- This is your main medical insurance, which covers medically necessary preventative care, doctors' visits, medical equipment, outpatient services, x-rays and lab tests, and some other services (like use of an ambulance).
  • Medicare Part C -- Unlike the first two parts, Part C is not actually a separate benefit. Part C is referred to as Medicare Advantage, which acts as an alternative to a regular Medicare plan. This plan can be obtained through private insurance companies and has some extra benefits (such as prescription drug coverage). This is an option for seniors who don't want an original Medicare plan.
  • Medicare Part D -- This part is specifically for outpatient prescription drug coverage. This plan is also only available through private insurance companies (in other words, you can't obtain it through the government like Original Medicare). However, you must have Medicare Part A and B to be eligible for Part D. For those who don't opt for Medicare Advantage, Part D is often a necessity because it covers prescriptions that aren't included in other parts of the plan.

If I Have Medicare Parts A, B, and D, Do I Need Medigap?

Surprisingly, even seniors who have three out of the four parts of Medicare listed above may still need Medicare Supplement plans. That's because there are actually a lot of medical costs that don't fall neatly under any one of those umbrellas, and without Medigap coverage, you may not be reimbursed or covered. For instance, doctor's visit copayments and out-of-pocket hospital costs won't be covered by Medicare Part A, so seniors without Medigap are often stuck paying those fees themselves. Medicare Supplement coverage can also be a bit daunting at first, since there are actually 10 different types of these Medigap plans to choose from. Each Medigap plan has its own letter of the alphabet (A, B, C, D, F, G, K, L, M, and N), and each type offers different amounts of coverage. You do need Medicare Part A and B to be eligible for a Medigap plan. At S2S Silver Services, we can help you find the right Medigap plan for your situation.

Is It Better to Get Medicare Advantage or Medicare Plus Medigap?

It really depends on your personal needs. For some, Medicare Advantage will be better because the copayments are often lower and coverage is consolidated. But on the other hand, your out-of-pocket fees may actually be higher with this type of insurance. If you need help paying for prescriptions, you should enroll in either Medicare Advantage or Medicare Part D. But a Medigap plan gives you access to a wider provider network and is often better for those with health conditions because it can save patients more money in the long term. S2S Silver Services can help you determine what type of Medicare insurance plan will be right for you.

At S2S Silver Services, we want to make the Medicare process easy and painless. If you need help deciding on the right Medicare plan, contact us today.

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