For many seniors, finding the Medicare plan with the right benefits and coverage options can feel like solving a mystery. Medicare beneficiaries generally choose Original Medicare, Medicare Advantage (which will provide you benefits equal to Medicare Parts A and B), or Original Medicare with a Medicare supplement (Medigap) plan to cover the portion Medicare doesn't. A person can't have Medicare Advantage and Original Medicare, with or without a Medigap plan, so it's an important decision to make when turning 65.
|Medicare supplement insurance plans
|Medicare Advantage plans
|You can select your doctors and hospitals as long as they accept Medicare patients.
|You may be required to use doctors and hospitals in the plan network.
|You can see specialists without referrals.
|You may need referrals and may be required to use specialists in your network.
|No network restrictions. Coverage goes with you across the United States.
|You may have network restrictions. Energency care is covered for travel within the United States and sometimes abroad.
|You can apply to buy a Medicare supplement insurance plan any time after you turn 65 and join Medicare Part B.
|Generally, there are specific periods during the year when you can enroll or switch to another Medicare Advantage plan.
|You pay a monthly plan premium in addition to your Part B premium. When you use services, your out-of-pocket costs are limited.
|Generally, you pay a low or $0 monthly plan premium in addition to your Medicare Part B premium. However, when you use services, you pay co-pays, co-insurance and deductibles.
Prescription drug coverage
|Prescription drug coverage is not included. Consider also purchasing a Medicare Part D plan.
|Prescription drug coverage can be included on some plans.
Navigating through the options offered by traditional Medicare benefits with supplemental insurance or Medicare Advantage plans brings retirees face to face with familiar questions, such as:
Medicare supplement insurance and Medicare Advantage plans have different answers to these questions. When weighing the advantages and disadvantages, two key factors are known medical concerns and needs, and expected income and resources going into retirement. A third consideration is your reasonable expected health care needs as you look to the future. Your family history, past employment, or an active lifestyle may require health services, such as knee replacements or other surgeries, down the road. But seniors should not let these choices stop them—those who delay enrollment may face long-term penalties.
Seniors often choose Medicare Advantage plans for low- or zero-cost plan premiums. However, zero-dollar premiums don’t mean free. The following common instances still require payment by the Medicare beneficiary:
Original Medicare with supplemental insurance is available to enrollees as they become eligible for Medicare Part B, usually at age 65 or due to disability. Participants pay regular Medicare premiums plus a supplemental insurance premium, and they can visit any doctors or specialists who accept Medicare assignment. This combination of plans allows enrollees to limit their out-of-pocket costs, except for prescription drugs, which are not covered. Seniors can purchase a stand-alone Medicare Part D plan to add prescription coverage. Additional features ease the minds of seniors, such as allowing them to move out of state without needing to enroll in a new plan.
Also, seniors have guaranteed issue when signing up for Medicare supplement insurance during their Initial Enrollment Period, which means there are no medical underwriting questions to answer. If a beneficiary wants to enroll in a Medicare Advantage plan now and switch to a Medicare supplement insurance plan later, that person may have to answer some basic medical questions to be accepted—so it’s important that individuals select the right plan for their situation up front.
It’s common for Medicare Advantage plans to include value-added services, such as hearing and fitness programs. It’s important for Medicare supplement insurance customers to look for these benefits as well, because they are becoming more common.
With WPS Health Insurance, the Medicare supplement insurance plan can include:
WPS also offers premium discounts, including a 7% household discount2 and a 2% discount for automatic premium withdrawal.