Choosing Medicare Options That Are Right for You

When you enroll in Medicare, one of the biggest decisions you’ll be faced with is deciding if you need to get additional coverage besides Original Medicare. Should you get Medicare Supplement insurance, sometimes called a “Medigap” plan? Do you want to join a Medicare Advantage plan that provides additional benefits like dental and vision? In this article, we will take a look at these optional types of coverage and give you some things to consider when deciding what’s right for you.

What is Medicare Supplement Insurance?

Original Medicare Parts A and B cover many health care costs, but beneficiaries are still responsible for their share, including deductibles, copayments, and coinsurance. Because these out-of-pocket costs can add up to thousands of dollars a year, Medicare Supplement plans are available from private insurers to fill in the gaps left by Original Medicare.

There are a variety of Medicare Supplement plans available. The various plan offerings have been standardized by the federal government. Each plan has a monthly premium, which is in addition to the monthly Part B premium that you must pay. You must be enrolled in both Medicare Parts A and B to purchase a Medicare Supplement plan. A Medicare Supplement plan cannot be combined with a Medicare Advantage (Part C) plan but can be paired with a stand-alone Part D plan.

How to Shop for a Medicare Supplement Plan

An easy way to start shopping for a Medicare Supplement plan is to look at a chart, comparing the plans side-by-side. Because Medicare Supplement plans have standardized plan names (Plan A, Plan C, etc.) and standard benefits, comparing plan costs between insurers is easier. 

You can see whether a plan covers what is important to you. For example, if you like to visit other countries, you may prefer a plan that includes foreign travel emergency coverage. If you want protection against the costs while in a skilled nursing facility, you could look for a plan with that coverage.

Once you’ve decided on one or more plans you’re interested in, then you can find out if they are available in your area and which insurance companies are offering them. We have many different Medicare Supplement plans available.

What is Medicare Advantage?

Medicare Advantage plans (also known as Part C) are offered by private insurers. These plans include all the services that Original Medicare does, and often include extras like dental, vision, hearing, fitness, and more. Medicare Advantage plans may also include Part D Medicare prescription drug coverage. You must be enrolled in both Medicare Parts A and B to purchase a Medicare Advantage plan and will still be responsible for your Part B monthly premium.

The major differences between Original Medicare and Medicare Advantage are:

• Medicare Advantage plans include an out-of-pocket maximum, which is a yearly cap on the amount a member will pay each year for covered services.
• Medicare Advantage works more like commercial insurance that you may be used to. Enrollees are encouraged to go to doctors or hospitals that are in the plan’s network, although some plans offer access to out-of-network providers. 
• Medicare Advantage plans include extra benefits that may include dental and vision. These benefits will vary by plan and insurance carrier.

How to Shop for a Medicare Advantage Plan

If you are considering a Medicare Advantage plan, the best way to proceed is to look for plans that are available in your area, such as Vermont Blue Advantage® plans, which are available throughout the state of Vermont.

Here’s a few things to check out when considering Medicare Advantage plans:

• Look at which of your current doctors are in a plan’s network, and which hospitals are in-network.
• Compare other features that are included, such as extra benefits like over-the-counter allowances, fitness coverage, and rewards programs.
• If Part D prescription drug coverage is included, review the plan’s formulary to ensure the drugs you take are covered.
• There may be a premium for being in a Medicare Advantage plan, although some plans have monthly premiums as low as $0.
• Out-of-pocket costs, like a copayment for a physician office visit, vary from plan to plan. You should compare what those costs are, as well as the yearly maximum out-of-pocket limit. 

Making Your Decision

When considering additional Medicare coverage, here’s some things to consider:

• If you want the ability to see any provider in the U.S. who accepts Medicare, Original Medicare paired with a Medicare Supplement plan and a Part D prescription drug plan may be a good choice.
• If you’re unsure how much you’ll be traveling outside your area, there are Medicare Advantage PPO plans that can have both in-state and out-of-state networks of providers.
• You’ll need to make a decision about whether to buy Medicare Supplement insurance when you initially enroll in Medicare. If you decide not to purchase a policy when you first age into Medicare, you may not be able to buy it later or you may have to pay more.
• You can add, drop or switch your Medicare Advantage plan during the Annual Enrollment Period, which takes place October 15 – December 7 each year. 

If you are considering adding or changing Medicare plans, our local experts are available by phone at 800-255-4550 (TTY/TDD: 711) from 8:00 a.m. to 4:30 p.m. Monday through Friday to offer you personalized attention in understanding your available Medicare options.

Vermont Blue Advantage is an independent licensee of the Blue Cross® Blue Shield® Association, providing Medicare Advantage Insurance. Vermont Blue Advantage is a PPO and HMO plan with a Medicare contract. Enrollment in Vermont Blue Advantage depends on contract renewal.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

H6898_VBAMdcrBlg_M CMS Accepted 10012024