Medicare Supplemental Insurance and Advantage Plans

Basics of Medicare Explained

When most Americans turn 65 years of age, they become eligible for Medicare. Original Medicare consists of Medicare Part A and Medicare Part B. Medicare Part A (hospital insurance) covers inpatient care, including care received while in a hospital, skilled nursing facility, and in limited circumstances, at home. Medicare Part B (medical insurance) covers medical services, doctor’s visits and supplies that are deemed medically necessary. They can include outpatient care, preventive services, ambulance services and some medical equipment.

If you are receiving Social Security or Railroad Retirement Benefits at the time you turn 65, you will automatically be enrolled in Parts A and B. If not, you will need to contact the Social Security Medicare office to apply for Part A and Part B prior to your 65 birthday.

If you do not sign up for Part B when you are first eligible, you may incur a late penalty that will last as long as you have Part B.

Supplemental Policies

Medicare Supplemental Insurance from BBX

For most services, after your deductible, Medicare Part B will pay only 80% of what Medicare decides is the approved charge for a particular service or treatment. You are responsible for the remaining 20% and there are no out of pocket maximums, which depending on the illness, can become insurmountable.

Medicare Supplemental policies (also called Medigap) help to cover these remaining expenses. The most popular Medigap plans are referred to as Plan G (with deductible) and Plan F (no deductible and available only to those who turned 65 prior to 2020). You are allowed to use any provider that you wish as long as they take Medicare. It is important to apply for a Medigap plan within 6 months of getting Part B coverage so that you are guaranteed issue without health questions.

Part D coverage is also necessary to cover prescription drugs. There are a variety of plans and premiums available. To determine the best plan for your needs, a list of your current medications, including the exact name, dosage and frequency is required. You may submit that information here.

To be eligible to purchase a Medigap policy or prescription drug plan, you must be enrolled in Medicare Parts A and/or B.

  Advantage Plans

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Medicare Advantage Plans are another way to get your Part A and B coverage and are sometimes referred to as Part C. These plans are offered by Medicare approved private companies that must follow the rules of Medicare. Most plans include prescription drug coverage (Part D). You must still pay your Medicare Part A and Part B premium when enrolled in an Advantage Plan.

A Medicare Advantage policy is NOT a Medigap plan. Different from Medigap plans, where you can use any provider you wish that accepts Medicare, an Advantage plan will require that you use a network of local providers so you must live within the plan’s service area. Each plan defines its own cost sharing in which you pay in the form of deductibles, co-pays and out-of-pocket expenses. These plans are always guaranteed issue with no health questions.

Providing a list of your doctors as well as your prescription medication will help us to determine which plan and network is the best for you. You may submit that information here.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 

For help in finding the right Medicare Supplemental or Advantage plan for you, Contact Us now.  We can help you navigate the complexities of choosing the right plan to cover your medical and prescription needs.