medicare advantage vs medicare supplement

Medigap Plan G vs Medigap Plan N | Choosing the Most Cost-Effective Option

Medigap Plans N and G - which plan should YOU choose? We look at the primary similarities and significant differences, plus 2 real-life examples that demonstrate why some Medicare beneficiaries should choose Plan N and others will find Plan G to be the most cost-effective option. Below we break down Medicare Part B Excess Charges, co-payments, premiums and state-specific exceptions - the most important considerations when evaluating Medicare Supplement Insurance Plans G vs N!

Medicare Supplement Insurance Plan G vs Medicare Supplement Insurance Plan N. You might’ve heard about them -they’re the most popular Medigap plans right now!

I’ll start by explaining 3 primary similarities between Plan G and Plan N. Next, I’ll highlight 3 significant differences between the two. Then, I’ll touch on premiums and state-specific exceptions. Finally, I’ll describe 2 real-life examples to help you understand why some people are better off with Medigap Plan G and others are better off with Medigap Plan N. Hopefully, this will shed a little light on the two most popular Medigap plans!

Let’s start with 3 primary similarities between Medicare Supplement Insurance Plans G and N. First, the Medicare Part A deductible IS covered under both plans. Second, the Medicare Part B deductible of $185 per year is NOT covered under either plan. Third, both plans cover hospitalization, skilled nursing facility care, blood, hospice care and foreign travel.

For complete coverage information, click the link in the description to access our Medigap Plan Comparison Chart.

Now let’s talk about 3 significant differences between Medigap Plan G vs Medigap Plan N.

First, doctor visit and outpatient co-payments. Plan G has no co-pays. Plan N has co-pays of up to $20 per office visit. Second, emergency room co-payments. Plan G has no emergency room co-pays. Plan N has a co-pay of up to $50 per emergency room visit. However, this co-pay is waived if you’re admitted to the hospital. Third, Medicare Part B Excess Charges.

Ok, you might be asking yourself, “What are Medicare Part B Excess Charges?” Allow me to explain! Medicare has a Fee Schedule. Some doctors, based on their education and/or training, don’t agree to the fee Medicare is willing to reimburse. These doctors are permitted to charge up to 15% more than the Medicare Fee Schedule permits. These are called Excess Charges. If no Excess Charges appear on a policy, the insured person must pay that additional 15%. While it’s fairly uncommon, some individuals will run into this as out-of-pocket expenses.

So, moving back to the third significant difference between Medigap Plans G and N: Excess Charges. Plan G covers Excess Charges of up to 15%. Plan N does not cover Excess Charges. For a comprehensive breakdown of the differences between Plans G and N, click the link in the description to access our Medigap Plan Comparison Chart.

In most states, Medigap Plan G generally runs about $20-25 more per month than Medigap Plan N. The condition of your health may determine which plan is best for you!

If you live in Wisconsin, Minnesota or Massachusetts, you won’t find “Medigap Plan G” or “Medigap Plan N” on the menu! Each of these 3 states has its own policy identification system. But fear not! We’re developing new videos that focus on each of those states. Be sure to subscribe to the SMS YouTube Channel so you don’t miss a thing!

So far, we’ve highlighted the 3 primary similarities and 3 significant differences between Medigap Plan G vs Medigap Plan N. We’ve also talked about premiums and state-specific exceptions. Now let’s see what this looks like in practice, using real-life examples.

In Example 1, Medigap Plan N is the better choice. Tom is a 74-year-old man. He lives a healthy lifestyle and doesn’t take any medications. The only time Tom sees a doctor is when he goes for his annual physical.

In this case, Plan N is the more cost-effective option for Tom. Here’s why: Tom will pay a lower premium for Plan N. Tom will have to pay a co-pay for his annual physical and any visits the emergency room. However, his annual out-of-pocket costs under Plan N will STILL be lower than the higher annual premium he’d pay for Plan G. If Tom selected Plan G, he would pay more money for coverage he doesn’t need! So Tom’s best option is likely Plan N.

In Example 2, Medigap Plan G turns out to be the better option. Linda is 68-year-old woman who lives a sedentary life. She’s a tobacco user who’s slightly overweight and has high blood pressure. Linda’s on several medications. She visits her doctor at least 4 times a year, if not more frequently. In this situation, Linda would benefit more from Plan G. Here’s why: Linda will pay a higher premium for Plan G. However, Linda will not have to pay co-pays for her doctor visits or any visits to the emergency room. Although Linda’s annual premium is higher under Plan G, her total annual out-of-pocket costs will exceed the amount she’d save on the Plan N premium because of her frequent doctor and/or emergency room visits. If Linda selected Plan N, she would likely end up paying more than the annual Plan G premium when the deductible and co-pays are taken into account! So Linda’s best option is likely Plan G.

While these 2 examples are great for demonstration, I encourage you to look beyond generic charts and bottom-line pricing. Finding the best plan to fit your needs AND your budget is what we do here at Senior Market Solutions! Our licensed Medigap Insurance Advisors do ALL the legwork so YOU can focus on living your life!

Medigap Plans N and G - which plan should YOU choose? Rick Teska of Senior Market Solutions discusses primary similarities and significant differences, plus 2 real-life examples that demonstrate why some Medicare beneficiaries should choose Plan N and others will find Plan G to be the most cost-effective option.

Misconceptions About Medicare Advantage Plans- A Question and Answer Session

Over the last thirty-five years, we’ve talked to thousands of Medicare beneficiaries about Medicare and their insurance.  We’ve heard it all quite frankly.  From the horror stories of denied coverage to the successful transitions to the Medicare program in general.  Year after year though as October 15th looms and Medicare’s Annual Open Enrollment is set to begin, that’s when the storytelling becomes larger than life.  Unfortunately, there is a lot of misinformation passed on this time of year to unsuspecting beneficiaries, we find the information is most common to the marketing of Medicare Advantage plans.  We’re setting the record straight this week and addressing some of the misconceptions that we often must address with the folks we talk to this time of year.

“I’m Still on Medicare.”

If you are on a Medicare Advantage Plan, you are not covered by Medicare A and B.

How SMS can help:  Medicare Supplement plans work in tandem with original Medicare, meaning your medical expenses can be covered at 100%.

“My Medical Needs Are Covered.”

Under Medicare Advantage plans, claims for medical and surgical procedures, primary care visits, specialist visits, home health care, physical therapy, and prescription drugs are frequently denied.

How SMS can help:  Any doctor or hospital that accepts Medicare will accept your Supplement plan, and any procedure, service, or therapy your doctor recommends will be covered by Medicare.

“My Coverage Is Clearly Outlined.”

Without federal standardization, Medicare Advantage insurers have wide discretion in determining coverage. Medicare Advantage policyholders frequently express concerns about gaps in coverage and hidden costs they were not made aware of upfront. Coverage information is not readily available or easily explained.

How SMS can help: Each Medicare Supplement plan has clearly defined federally standardized benefits.  Our customers easily review the costs and benefits of each plan before selecting the plan best suited to their needs.

“I Can Choose My Doctor.”

Medicare Advantage covers a limited network of doctors, hospitals, and nursing facilities. Your approved list of providers will change year to year, potentially leaving you with fragmented care. Finding care while traveling will be difficult.

How SMS can help: Supplement plans cover any provider who accepts Medicare.  Your coverage goes where you go, giving you the freedom to travel good in all 50 states.  Some Supplement plans even provide limited medically necessary emergency care outside the country.

“I’ll Save Money with Medicare Advantage.”

While most Advantage plans have low premiums, out-of-pocket maximums range from $4,000-$9,000. Patient costs of Medicare Advantage plans can easily climb higher than those of combined Medicare and Medigap coverage.

How SMS can help:  Medicare Supplement’s low monthly premiums allow customers to plan financially.  Without hidden costs, our customers enjoy peace-of-mind, knowing exactly how much their care will cost when health issues inevitably arise.

 “I’m Covered in An Emergency.”

Medicare Advantage beneficiaries commonly complain about denied benefits during an emergency or urgent care.  On top of a health crisis, customers are hit with enormous out-of-pocket costs.

How SMS can help: A Medicare Supplement plan ensures coverage wherever Medicare is accepted, including emergency facilities.

“The ‘Affordable Care Act’ Won’t Affect Me.”

As a result of changing health care laws, Medicare Advantage plans have been de-funded. Premiums are increasing, benefits are decreasing, and doctors are leaving networks. Changing benefits leave Medicare Advantage patients with less coverage while they scramble to find new providers.

How SMS can help: Medicare Supplements are not annual contracts.  The government has standardized each plan for simplicity, guaranteeing the same benefits year after year.

“I Can Switch to A Medicare Supplement Whenever I Need To.”

If your health declines while you are a Medicare Advantage customer, you risk becoming ineligible for a Medicare Supplement plan.  Medicare Supplement plans require the insured to pass medical underwriting.

How SMS can help: Senior Market Solutions contracts with over twenty-five major insurance carriers, each with different eligibility requirements.  Let us help you find a plan to meet your needs, regardless of your current health.

Senior Market Solutions - Find The Best Medicare & Medigap Plans

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