Simplify Your Medicare Supplement Decision Making by Focusing on Just 5 Things
Your MEDICAL CONDITIONS will determine the CARE that you need.
The CARE required will determine both your need for CONTROL and the COSTS you incur.
CONTROL refers to the following:
The ability to see any provider (doctor, hospital, urgent care, etc.) of your choice without having to work through provider network.
The ability to undergo any test or treatment your doctor recommends as long as it is a covered Medicare benefit. This means that you would NOT have to worry about getting pre-authorizations or pre-approvals for your treatment or testing.
In other words, having CONTROL means that both you and your doctors have freedom of choice about your care.
Original Medicare (or Medigap) plans offer the greatest extent of control.
COSTS are primarily incurred in 2 ways:
Up Front Costs: These are based on the premiums you may pay. With these plans your medical costs in any given year will never be greater than your annualized premium + a small deductible. (The Medicare Part B 2026 deductible will be $288)
The example above is for a Medigap Plan G which offers the most comprehensive coverage. (Plan G also has the highest premium of the Medigap Plans). There are other Medigap plans with lower premiums although these would be associated with varying degrees of co-payments and co-insurance. However, it is also important to note that ALL Medigap Plans will still allow you and your doctor the freedom to have CONTROL over your care (as outlined above)
Pay as You Go: Most of these plans fall into the category of Medicare Advantage (also called Medicare Part C) plans.
These plans typically have either little or no premium, meaning you will often NOT pay anything unless some type of treatment is required.
Co-payments and/or co-insurance is paid when care is received and the extent of such co-pays or co-insurance is dependent on the type of treatment or testing required.
Medicare Advantage Plans also usually have a higher yearly maximum out of pocket limit (called MOOP) as compared to Medigap Plans.
COLLATERALS are the 4th factor to consider, meaning things that are included with the plan at no extra charge such as:
Dental Benefits
Fitness Benefits
Grocery and Over-the-Counter Spending allowances
Vision and Hearing Benefits.
Some plans even offer a monetary “giveback” to help offset Medicare Part B premiums.
CASH FLOW: Here you ask yourself is it better to spend your money on premiums up front to have freedom and control of your care or is it more important to have minimal to no premiums yet still have the collateral extra benefits knowing that you give up some degree of freedom and control of your care.
examples of medicare supplement choices and the reasons the choices were made
john, spinal surgery, and pain management
John had a low back fusion just before turning age 65 and since that time has had ongoing pain and the need for both physical therapy and pain management.
His primary doctor, and pain management doctor, are both in a specialty group that does NOT accept Medicare Advantage Plans.
Although his Medicare Supplement premiums are difficult for John to afford (at $210 per month), the yearly cost of his premiums ($2520 per year) are still less than what he would otherwise pay in co-pays and coinsurance for the frequent medical care that he requires.
John also has developed a trusting relationship with his doctors and knows that his Medigap plan would allow him to continue seeing them without worrying about network restrictions.
mary, very healthy, financially secure in retirement
Mary retired with considerable financial assets allowing her to live without having to worry about here day-to-day expenses and also have the money to do the things she enjoys.
She remains healthy and active with no current medical problems
However, even though healthy, Mary wants complete freedom of choice if she needs to see a doctor and does NOT want to deal with medical cost containment such as pre-authorizations or the requirement to see only network providers.
Although healthy and recognizing that she may spend money on premiums without currently needing medical care, it is more important to her to preserve her freedom of choice by paying her premiums, the cost of which, will NOT negatively impact her quality of life.
ron and cindy, healthy, active, and financially stable,
This is actually me and my wife. We are healthy, active, and rarely see doctors except for routine yearly checkups. We are also comfortable having to see network doctors as we have not yet developed any relationship with a particular doctor or specialist.
Although financially stable, we chose a Medicare Advantage Plan because we did NOT want to spend money for premiums, especially since our current needs for medical care are minimal.
We have had an Advantage Plan for 5 years, during which time we have saved about $23,000 on premiums (combined for both of us) that we would have otherwise paid.
Additionally, our plan has given each of us numerous extra benefits NOT found with standard Medigap plans. ($2500 per year dental allowance, $45 per quarter over the counter spending allowance, Free fitness club membership, and $800 per year for fitness related supplies.
we need to watch our money carefully
These 3 people live in the same neighborhood and, although working all of their lives, have been able to save just a small amount of money and currently live on below average social security benefits.
The Medicare Part B premiums have been increasing and are now compromising their ability to afford day-to-day living expenses.
Because maintaining a livable cash flow is more important to them than having complete freedom with their medical care, they have opted for a premium give-back plan to help offset what they pay for their Medicare Part B premiums. They also like the extra dental, vision, hearing, and expense allowances that are included as a part of their plan.
Grandma has mutiple health issues
Grandma has dealt with numerous health issues over the years including heart problems and diabetes.
She has just turned 65 and, because her company has less than 20 employees, will be obligated to sign up for Medicare.
Grandma has decided that, even though money is tight, she will enroll in a Medicare Supplement that will cost here an additional $150 per month on top of her Medicare Part B premium.
She has chosen this because of being in her guaranteed issue period for a Medigap plan and they cannot deny her or charge a higher premium due to her health conditions. She also knows that, outside of this guaranteed issue period, it would be unlikely she would qualify for Medigap
