It’s a pretty turbulent time in American healthcare. Republicans in office, led by President Trump, are determined to “repeal and replace” Obamacare (or the Affordable Care Act, aka ACA), and accordingly the House of Representatives have taken the first step toward passing a new act called AHCA (The American Health Care Act). However, there are indications that AHCA as currently written cannot pass the Senate, which means right now we really don’t know what the near future holds. This effort could break down and leave us with Obamacare, or something very close to it – or we could see a new bill that, at the time of this writing, we can’t quite imagine.
All this means right now, however, is that it’s more important than ever for Americans to educate themselves about their own healthcare systems and benefits. So in this article we want to delve into some of the specifics of Medicare, and specifically the pros and cons of Medicare Supplement Plans and Medicare Advantage Plans.
While some consider Medicare to be among the more admirable and far-reaching healthcare programs in the world, it doesn’t cover everything. Original Medicare sometimes fails to cover some standard medical visits (such as dental), and still requires occasional copayments and that deductibles be met. Additionally, you will find some deals for certain medical appointments that might exclude federally funded programs, meaning they’re not necessarily available for those covered by Medicare.
Look at retired people, and even those who have been forced to go out on disability. For many, they still rely on regular treatments and everything from chiropractors to mental health physicians are rarely covered under such plans. It’s for reasons like these that many who have this kind of coverage ultimately look into Supplement Plans and Advantage Plans. Simply put, they can lead to more comprehensive coverage.
Medicare Supplement Plans
Sometimes referred to as “Medigap” plans, these are meant to pick up the slack that Medicare doesn’t take care of – or, in other words, fill in the gaps. According to MyMedigapPlans.com, you can expect to cover some extra deductibles and additional medical expenses that simply aren’t covered with Medicare once you implement a Medigap Plan. You’ll also get coverage for up to a year’s worth of additional days in the hospital, and enrollment is generally thought to be fairly easy and accessible.
The main “con” to this kind of plan is of course that you still have to pay for it, and the monthly premiums can be fairly pricey. It’s up to each individual to determine whether or not these premium costs will be worth it to cover some of the potential medical expenses that would otherwise need to be made out of pocket under Original Medicare. Another con is that you will not be able to pay for drugs under a Medigap plan, and certain procedures may not always be covered.
Medicare Advantage Plans
A Medicare Advantage plan represents a whole different kind of insurance, though it works similarly to the combination of Original Medicare and a Medigap plan. Basically, committing to this kind of plan means abandoning Original Medicare in favor of a more comprehensive (but sometimes more expensive) version of it. You’ll have similar coverage to those using Medigap plans, though there’s an argument to be made that your setup will be simpler, given that everything is under one umbrella. It’s also worth noting that you may be able to find a Medigap plan that specifically includes prescription drug coverage.
The downside to Medicare Advantage is that it can be slightly less stable than a more ordinary Medicare plan, in that it relies on private insurance companies and can therefore change over time. Private insurers offering Medicare Advantage plans have to be approved by Medicare in order to offer this type of coverage, but details (including premiums and out-of-pocket costs) can shift from one year to the next.
Ultimately, both plans offer terrific medical care, essentially serving to make Medicare more complete. If you’re currently considering enrollment, you will want to keep a close eye on the political developments and make sure you’re aware of your options. But right now, these Medicare add-ons are still available to those eligible for basic Medicare, and that makes them well worth considering.