Medicare annual open enrollment starts soon. Will you be prepared? Will YOUR doctor accept your new plan? Who is in charge of your health care? You, or an insurance company?
Most Doctors Accept Medicare Assignment
The next time you make an appointment with your doctor, will you be turned down? While most doctors accept Medicare assignment, about half do not participate in one or more Medicare Advantage plans.
With original Medicare and a Medicare supplement plan, you get to pick your doctor.
When you have an Advantage plan, the insurance company makes that decision for you and presents you with a list of “acceptable” doctors.
Medicare open enrollment is around the corner and many wonder if they are better off with an Advantage plan or Medigap coverage. The “right” answer is . . . it depends.
The Basics of Georgia Medicare Plans
Original Medicare only covers 52% of your health care costs, so unless you are wealthy, you need additional insurance to help pay your bills. Seniors in Georgia can choose from two types of private health insurance . . . Advantage plans or Medicare supplement plans (also known as Medigap).
Before you can enroll in an Advantage plan or Medicare supplement plan you must have Medicare Part A and Part B. Most do not pay a premium for Part A but will pay the Part B premium via deduction from your Social Security check.
Advantage plans and Medigap plans have monthly premiums that are determined by your age, your gender, where you live and the type of coverage you want.
How Do Medicare Advantage Plans Work?
Most Advantage plans have doctor and hospital networks. Some allow you to use medical providers that are outside their network, some do not. If you have a plan that provides out of network coverage, it only applies if the doctor or hospital agrees to accept the plans terms and conditions of payment.
It is not unusual to find that half the doctors in your county do not participate in Advantage plans or they may currently accept SOME Advantage plans but not others.
Some Advantage plans cover prescription drugs, some do not. For our purposes we are only considering plans that do not include Rx coverage.
Advantage plans have copay’s for doctor visits, outpatient hospital services, ambulance, Emergency Room, durable medical equipment (DME), diabetic supplies, diagnostic X-ray and lab services and so forth.
The copay may be a fixed amount, such as $20, or it may be a percentage of the charge levied by your provider. Typically you are required to pay 20% of the approved charge.
Every time you utilize these medical services you will need to verify that the provider is “in network” or that they agree to accept the terms and conditions of your plans payment schedule.
In short, with a Medicare Advantage plan you use THEIR doctors, not yours.
Medicare Supplement Plan N
If you have original Medicare and Medigap plan N your plan works like this.
You may use any doctor, or any hospital, that accepts Medicare assignment. In your county almost every doctor and hospital participates in Medicare and has no trouble accepting assignment or your Medigap plan.
Your doctor bills Medicare. They review the claim and when it is approved, Medicare bills your supplement plan carrier.
Your doctor never knows, nor do they care, which carrier handles your Medigap coverage. All gap plans with the same letter are identical so you should pick the plan with the lowest premium.
When you pick Medigap plan N you are required to pay your Medicare Part B deductible (currently $162) plus up to $20 for a doctor visit; up to $50 for a visit to the Emergency Room.
With original Medicare and Medigap plan N, you use YOUR doctors, not theirs.
Which makes more sense?
Buying a plan that requires you to use THEIR doctors plus you pay 20% of an unknown amount every time you use the plan, or buying a plan that lets you use YOUR doctors and limits the amount you pay to $20.
Georgia Medicare Plans has affordable Medigap plans for GA seniors. Use our GA Medigap Quotes link to find plans, compare rates and decide which plan best fits your needs and budget.