How to Simplify Your Coverage Choices
*You must have Medicare Parts A & B for both options below and continue paying your Medicare Part B Premium
Add one or both of the following to Original Medicare:
Choose a Medicare Advantage Plan:
With so many Medicare Advantage, Medicare Supplement, and Part D choices available, Option 1 or Option 2 sounds too simple to be true! However, in most initial consultations, the chart above assists us in eliminating several coverage options that won’t be suitable for your needs.
The reason we divide this chart into two distinctive paths is because you can only choose one set of benefits: Original Medicare (with optional Supplement and/or Part D) or a Medicare Advantage plan.
Let's Start with OPTION 1
This option begins with Original Medicare Part A and Part B as primary insurance which allows you to access any Medicare accepting provider or facility in the U.S.
Because Original Medicare does not have an “out-of-pocket-maximum” for Part A and B benefits, you could be liable for some unpredictable costs. This is why most of our clients choose a Medicare Supplement Plan as secondary coverage. It helps fill in the gaps that Medicare leaves behind such as deductibles and coinsurance.
Original Medicare with a Medicare Supplement plan feels very similar to a PPO because there is no requirement to have an assigned Primary Care Physician or referral to see a Specialist.
Original Medicare Parts A & B does not include Part D prescription drug coverage, so this benefit would be added through a Stand-Alone Part D plan offered by Medicare approved private insurance companies.
Moving on to OPTION 2
This option is known as Medicare Advantage or Part C, which is an all-in-one alternative to Original Medicare. These plans include coverage for Part A, Part B, and usually Part D, and are offered only by private insurance companies.
Medicare Advantage plans may have lower out-of-pocket costs compared to Original Medicare. In addition, they may also include ancillary benefits.
Each Medicare Advantage plan will have a specific service area such as Los Angeles and Orange County, Santa Barbara and San Luis Obispo County, or San Diego County. This also means that they will have a unique provider network. In an HMO, a referral from your chosen Primary Care Physician would be required to see a Specialist.