Supplements

Also known as “Medigap” plans because they help cover the out-of-pocket costs (“gaps”) of original Medicare. They are sold by private health insurance companies. The plans are standardized by the government (CMS) which makes it easier for you to compare companies. The most popular Medicare supplements are the plan F & G. You can purchase either a select supplement (Avera and Sanford in SD) or a “traditional” supplement. We help you understand and go over the similarities and differences between the two types.

Typically when you buy a supplement you are “pre-paying” for services on a monthly basis whether you use the plan (that is go in to see a provider) or not. Many people say that having this type of plan provides them “peace-of-mind” because they know if something happens it will be covered so long as it is Medicare approved.

MEDICARE ADVANTAGE HEALTH PLANS (Part C)

These type of plans are often referred to as “pay-as-you-go” plans and have premiums that start at $0/month which typically include your part D coverage as well (which are then referred to as MAPD plans). So, if you don’t go into a provider or need any services you pay nothing at all. You do have to have Original Medicare (parts A & B) to enroll in one of these plans just as you do if you choose to purchase a supplement so you will have to pay your monthly part B premium.

Most of the Advantage Plans in SD are PPO’s (Preferred Provider Organizations) which gives you the option to go to any provider that accepts Medicare with participating providers (in-network) offering lower costs (copays) than non-participating providers (out-of-network). Keep in mind with a PPO that you can go to any provider that accepts Medicare just like you can with a Medicare supplement. It’s just a matter of weather they are in- or out-of-network. Currently there is only one HMO (Health Maintenance Organization) in SD. This type of plan only allows you to see participating (in-network) providers. Keep in mind that with all Medicare plans that you are covered for emergencies anywhere in the U.S.

We can help you understand and compare these types of plans to see if they might be right for you. These plans have to be as good as or better than original Medicare with many of them offering extra benefits like vision, hearing, dental, and more at no additional cost. There’s even a plan that offers a Medicare Savings Account (MSA) that is similar to a high deductible Health Savings Account (HSA) that you may have had while you were on your employer coverage.

Cost Plans

Medicare cost plans are sometimes referred to as “hybrid” plans because they offer benefits that are found with both supplements and advantage plans. You can purchase them with or without part D coverage. If you get one without part D then it is recommended that you purchase a stand-alone part D plan (PDP) to go with it which is what you have to do with a supplement. These plans require you to have both Medicare parts A & B (Original Medicare) in place and offer a monthly premium that is typically lower than the supplemental plan F & G’s.

Cost plans have copays just like advantage plans do. There is a network of providers that you are required to see when you are in their coverage area; however, because you retain the use of your original Medicare card, you still have the ability to go to any provider that accepts Medicare. And, if you travel outside of the coverage area you are allowed to see any provider that accepts Medicare just like you can with a “traditional” supplement. There are some restrictions when traveling with this type of plan that we would be happy to go over and help you understand, but all-in-all most people find them to be just as easy to travel with as supplements are. These plans also offer extra benefits like vision, hearing, and dental just like advantage plans do.