If you are reading this, you are probably eligible for Medicare or getting close to qualifying! When researching private Medicare plans, you have two main options:
- Part C Medicare Advantage Plans (with or without Part D drug coverage)
- Medicare Supplement Plans (paired with or without standalone Part D drug coverage)
In general, people sign up for private Medicare plans to help reduce costs. Some plans may be better at reducing costs compared to others. Keep in mind — medical costs are not the only health care expenses you need to worry about when Medicare eligible! (we will discuss this in greater detail later in the article)
Everyday people ask me, “what is the best Medicare plan?” The answer — it depends! Each person’s needs and budget are different which means there is no ‘one size fits all’ plan.
In this article, I am going to discuss some of the main reasons why people enroll in Medicare Advantage Plans. You can also watch the informational video to learn more!
Before we talk about the top reasons to enroll in a Medicare Advantage plan, let’s review some basics. For starters, you need to know if you qualify for a Medicare Advantage plan.
The general rule of thumb is that you need to be enrolled in Part A and Part B to get a Medicare Advantage plan. Contrary to popular belief, you do not need to be 65 years old to get a Medicare Advantage plan!
This means that if you are disabled, you can improve your coverage and get a Medicare Advantage plan to reduce your out of pocket costs! Best of all, there are never health questions on Medicare Advantage plans! Unlike Medicare Advantage plans, Medicare Supplement plans can ask health questions. Here is an example set of health questions on a Medicare Supplement plan:
Not being able to ask health questions is one of the main reasons why people choose Medicare Advantage plans. Every year, you can switch from a Medicare Advantage plan into a new one, no health questions asked. The main time people switch Medicare Advantage plans is during the Annual Enrollment Period.
This flexibility of getting a plan and changing every year is one of the main reasons why people enroll in Medicare Advantage. The Kaiser Family Organization tracks enrollment numbers every year for health care. Over the past decade, Medicare Advantage enrollments have doubled! (and it is no surprise!)
Another main reason why people enroll in Medicare Advantage plans vs. Medicare Supplement plans: affordability. Medicare Advantage plans in Nevada usually have $0 premiums and low out of pocket costs. This is not just a trend in Nevada:
On the other side of the fence, Medicare Supplement plans have monthly premiums on all plans. These premiums increase as time goes on based on your age. The grid below outlines illustrative premiums for men in Northern Nevada and how they increase over time. These Medicare Supplement Plan G rates are used for illustrative purposes so you can estimate the expected costs:
For women, rates are a little lower since women are lower risk in their 60’s, 70’s, and 80’s. Regardless, the premiums still increase every year. The grid below outlines illustrative premiums for women in Northern Nevada and how they increase over time. These Medicare Supplement Plan G rates are used for illustrative purposes so you can estimate the expected costs:
Even though these Medicare Supplement plans have higher premiums, they usually have much lower out of pocket costs for approved Medicare services. Here is a sample chart of all the Medicare Supplement plans, including the Plan G referenced above:
In 2023, the Plan G has a Part B deductible of $226. After spending $226 in approved Medicare services, you will then receive 100% coverage for the rest of the year with Medicare doctors.
You may be scratching your head wondering why Medicare Advantage plans are becoming more popular than Medicare Supplement plans. Paying $226 for approved medical services in a calendar year sounds fantastic! Unfortunately, Medicare Supplement plans do not cover extra benefits like dental, vision, hearing aids, gym memberships, over the counter supplies, and more!
Getting these extra benefits is one of the main reasons why people choose Medicare Advantage instead of Medicare Supplement plans. Good news for you — most Medicare Advantage plans include extra benefits, as seen below.
Low Out of Pocket Costs
At the core of the coverage, Medicare Advantage plans still have the main goal of covering your health care costs. On a nationwide scale, Medicare Advantage plans have relatively low maximum out of pockets as seen below.
In Nevada, we see maximum out of pockets ranging from roughly $1,500 to $6,000 on average. This maximum out pocket is a safety net meant to protect you. If you do not use your plan, you do not need to pay this maximum out of pocket.
For people enrolled Medicare Supplement plans, they are required to pay their premiums every month regardless if they use the coverage or not! This can add up very quickly. At a certain age, people pay more in Medicare Supplement premiums annually compared to the maximum out of pocket on an alternate Medicare Advantage plan. Based on a simple calculation comparing these costs, we usually see people switch from a Medicare Supplement to a Medicare Advantage Plan around the age of 70.
Great Coverage for Veterans
One of the main Medicare populations not talked about often: Veterans.
Veterans can continue to seek care at their local VA facility while enrolled in a Medicare Advantage plan. Getting a Medicare Advantage plan does not disrupt the coverage or care they receive at the VA.
As a Veteran, there are few main benefits to getting a Medicare Advantage plan:
- Adding a Medicare Advantage Plan usually costs $0 (ie. no monthly premium)
- Coverage for Emergency and Urgent Care situations
- Access to additional doctors outside the VA (for a second opinion or specialized treatment plan)
- Extra benefits like dental, vision, and hearing aid coverage
- Added protection against high medical claims
Medicaid & Medicare Beneficiaries
If you qualify for both Medicaid and Medicare, a Medicare Advantage plan is most likely your best option. People enrolled in both Medicaid and Medicare are known as “dual eligible”.
There are other forms of dual eligibility. To learn more about these other types of dual eligibility and special needs programs, please click here. When someone is dual eligible, they may qualify for a high benefit Medicare Advantage plan, known as D-SNP.
These D-SNP plans have very low and sometimes no out of pocket costs. These D-SNP plans are becoming very popular since they keep health care costs affordable and easily accessible.
From a trend perspective, Medicare Advantage plans are becoming more and more popular! These plans cover the needs of people from all walks of life. With bipartisan sponsorship from a political perspective, Medicare Advantage plans are here to stay (and may be the way of the future for everyone enrolled in Medicare)!