If you are around the age of 65, then you are probably in the process of enrolling in Medicare if you aren’t receiving benefits already. Medicare Parts A and B are what make up the base of Traditional Medicare benefits. The chart below outlines exactly what sort of benefits Medicare recipients can expect, from hospital care to outpatient treatment. But there are some treatments which aren’t covered – referred to as “coverage gaps” – that could end up costing a lot of money if you don’t take the proper precautions.
Coverage and Benefits
Medicare costs start out with Medicare Part B. There are low-cost monthly premiums required of every beneficiary, as well as deductibles which you can calculate on this website. Part A, however, is a little bit different. For many seniors, Part A is free. However, if you have a short employment history, you will be required to pay a deductible for access to Part A benefits. Anything shorter than 10 years or 40 quarters will put you in the category of mandatory deductibles for Medicare Part A.
Did you know that Medicare Part A and Medicare Part B aren’t necessarily a package deal? While it’s true that you must accept Medicare Part A and the hospital/hospice medical benefits it provides, you don’t necessarily have to accept Part B. But this can be tricky because in order to get benefits like Part D prescription drug coverage, you will have to accept the preventative care and outpatient benefits which Part B provides. But some seniors are reluctant to do this because Medicare Part B can be substantially more expensive than Medicare Part A.
In some ways, this mandate is also reflected in Medicare Part C. Medicare Part C is a private health insurance policy, also often called Medicare Advantage, which you purchase from a private company. Legally, this policy must include all of the same healthcare benefits you would get from a Medicare Part A and Medicare Part B bundled package. The government will not allow them to offer you any less coverage without facing serious consequences – even if you’d rather not have the Part B benefits on your policy.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Various Medicare Plans in Oklahoma
More than half a million seniors – 625,924 to be precise – are currently taking advantage of the Medicare benefits program. Of those, 61% either aren’t protecting against their coverage gaps with supplemental insurance, or they are covered by some sort of employer program. Of the remainder, the most popular solution is a Medigap insurance policy. 23% of seniors in Oklahoma have one, for a total of 144,292 beneficiaries. The less popular option, Medicare Advantage makes up 16% of all beneficiaries, or 100,148 people.
Seniors approaching the age of 65 should be enrolled in Medicare, or at least starting the process. If you need help with Medicare enrollment, click the link provided.
Is Supplemental Coverage Absolutely necessary?
In short, no. There is certainly no legal requirement for it, anyway. But you should keep in mind the coverage gaps we’ve talked about so far. The chart below describes only some of the out-of-pocket expenses you might be footing the bill for if you suffer a medical emergency and are covered by nothing other than Original Medicare benefits:
|Medicare Part A Costs||Medicare Part B Costs|
But there are ways to protect yourself. As discussed earlier, Medicare Advantage and Medigap supplement insurance are two of the most popular means by which seniors insure themselves against coverage gaps. We’ll discuss each option further in this article, and give you the information you need to make a choice between the two.
Oklahoma, as a state, is often overlooked and underrated; unfortunately, this is not the case when it comes to the expensive costs associated with getting healthcare in Oklahoma. Furthermore, these costs aren’t going to lower themselves anytime soon. As a senior citizen, it’s important for you to take this into account when you retire. The cost of healthcare will keep rising right alongside the frequency with which you will need medical care. If you don’t take action to protect yourself now, your finances could be in very real danger.
And you need to protect yourself because Medicare doesn’t cover as much as you think it does. In the long run, it is highly likely you will require extended hospital stays, hospice care, or so much outpatient treatment that your coinsurance rates skyrocket. And guess what? Medicare benefits won’t cover any of these expenses – but you will be expected to.
Amongst all this doom and gloom there is good news; some supplemental insurance policies are available to help you protect yourself from these Medicare coverage gaps. Many of your available choices are simple to understand and very affordable. Unfortunately, this is not the case for all seniors in all locations. But we can help explain some of your choices so that it’ll be easier for you to make a decision.
It would be great if there were a one-size-fits-all supplemental insurance policy for the gaps in Medicare coverage. Unfortunately, everyone has their own unique healthcare needs, so coming up with such an insurance plan is impossible. This is why it’s so important for you to make an educated estimate of what your healthcare needs might be in the future before you make a serious, long-term decision.
Option #1: A Medicare Supplement Plan
More often than not, these are referred to as Medigap policies. When you purchase a Medigap policy, you choose between one of ten available plans (outlined below) from a private health insurance company. If you suffer a medical emergency, and Medicare is incapable of covering your expenses, then the benefits from your Medigap policy will kick in and help make up the difference. For the sake of convenience, each plan offers the same benefits, regardless of where you live. Therefore, the only variables that will change from state to state are the provider, and the overall price of the policy.
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$89||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$96||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$74||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$86||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$64||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$124||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$69||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$60||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$40||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$81||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Option #2: A Medicare Advantage Plan
Medicare Advantage gets a little more complicated. Also known as Medicare Part C, an Advantage policy is an alternative to Traditional Medicare offered by a private health insurance company who is legally required to offer you the exact same benefits as your original Medicare policy, if not better. Sometimes, this “better” coverage comes in the form of a dental plan or prescription drug coverage. And many Medicare Advantage customers are happy with the simplicity of managing all their medical benefits under one single policy.
There are some negative aspects of Medicare Advantage, however. For starters, your network of doctors and physicians will be limited in order for your insurance company to keep their costs down. If you are thinking about switching to an Advantage policy, keep in mind that being forced to switch to an in-network doctor is a very real possibility. This might be an easier switch for some to make than others.
With Medicare Advantage, doctors and facilities must be a part of their Health Maintenance or Preferred Provider Organization (HMO and PPO, respectively) in order to receive care. Otherwise, you could be paying out-of-pocket.
Understanding Medigap vs. Medicare Advantage
There are actually several differences between these two insurance policies. In some ways, they’re practically as different as night and day. This means that one plan may work especially well for you while the other one is a significantly inferior option.
If you think about these two policies like a battle between David and Goliath, the Goliath in this scenario is definitely Medicare Part C (Medicare Advantage). Medicare Advantage not only replaces Original Medicare with identical Medicare Part A and Medicare Part B benefits, but it gives you several different additional coverages to choose from. You can add benefits which cover Medicare gaps, dental coverage, vision coverage, and even a private prescription drug program.
Then there’s the David of this battle: a Medicare Supplement insurance policy (Medigap). Medigap policies do exactly what the name implies – they cover the gaps in your Medicare Parts A & B coverage so that your savings won’t have to. Very comprehensive plans will pay for all the Part A coverage gaps and many different Medicare Part B expenses like coinsurance, co-pays, or monthly premiums. It is a much more secure policy and all you have to do is pay one low monthly premium for all your benefits. But you don’t have the option of adding any more coverage then the policy provides.
Medigap insurance offers seniors 10 different plan options which are standardized for every state in the Union. Plan F in Texas will offer the same benefits as Plan F in Alaska, to be precise. It’s also nearly universally-accepted, just like Medicare is; the same cannot be said for Medicare Advantage. There are fewer guarantees and protections with Medicare Advantage as well as fewer doctor and hospital choices because of their restricted networks. But this can financially benefit some seniors.
Discussing all of the differences between Medicare Advantage and Medigap could probably fill a book. But we know you don’t have time to spend extensively researching the subject. That’s why we want to help you find a quick and easy solution to your healthcare needs. Just call us up and talk to one of our friendly representatives today – we may even be able to find you an affordable quote on a policy that’s just right for you.
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||When your provider figures out what your monthly premiums should be, they send Uncle Sam the bill. After that, any excess monthly expenses will be your responsibility.||You will receive a quote from your provider and you must agree to pay one low monthly premium if you want to purchase a policy.|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||Costs include your monthly premium (if you have one), and whatever your provider decides is appropriate for your co-pays and coinsurance.||Medigap policies start by costing you an affordable monthly premium. If you have a less comprehensive policy, you will be responsible for a larger share of your coinsurance or co-pays – but your monthly premium will be lower as a result.|
|What will the plan cover?||The base package starts with coverage benefits which are identical to Medicare Parts A & B. You have many additional coverage options to choose from beyond that, such as prescription drugs or gap coverage.||Some plans only offer gap coverage associated with Medicare Part A; more comprehensive plans offer Part A gap coverage, most aspects of Part B gap coverage, and even things like traveling abroad coverage.|
|Is it easy to budget my healthcare expenses?||This all depends on how frequently you need care. Frequent and unexpected trips to the hospital or doctor’s office will increase your healthcare costs and make your budget less predictable.||The more comprehensive your plan, the easier it will be to budget.|
|Is my plan guaranteed? Or can it be cancelled?||The guarantees for a Medicare Advantage policy are few and far between. You can lose coverage at any time at your insurance company’s discretion.||You cannot be denied or lose coverage with a Medigap policy unless the company goes out of business or you stop paying your premiums for whatever reason.|
|Do I have to clear a pre-approval or pre-certification process?||Unlike the government, private health insurance companies are allowed to pre-screen you before agreeing to issue a policy.||Nope! All you have to do is qualify for Medicare. It’s that easy.|
|Am I limited to specific doctors or hospitals?||You will have a smaller network of doctors and hospitals to choose from with Medicare Advantage. In larger cities with a higher population density, there may be so many different choices that it won’t seem inconvenient to you.||Wherever Medicare is accepted, Medigap is accepted. It’s as simple as that.|
|What type of plan is best for me?||The more coverage you need, the more care you need, the more populated the area you live in, and the healthier you are, the more a Medicare Advantage plan might make sense for you.||Medigap plans are more appropriate for older seniors who require frequent care, who aren’t so concerned with bells and whistles coverage, and who want to control the unpredictable Medicare coverage gaps for one low monthly premium. It’s also helpful for seniors who wouldn’t otherwise pass a pre-approval process or who could end up seeing their coverage disappear if their healthcare costs become too demanding.|
Additional Resources and Information for Oklahoma Seniors
Still have questions? That’s actually a good thing. The more information you have at your disposal, the easier it will be to make the right decision about your health care needs. We’ve included this directory of contact information for local Medicare insurance offices in your area. By contacting and talking to experts in the Medicare field, you’ll be empowering yourself to make the right choice.
Choose at least one topic area you are interested in: Select All
Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
Important Medicare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.