Medicare Advantage is Less Expensive for a Reason: Beware | Health, Medicine and Fitness
Lower premiums are great until you get sick and the bills pile up
The smart way to shop for any type of insurance is to arm yourself with courage and imagine the worst. The house is on fire. The car is totaled. With those “what ifs” in the front and center, you’re more likely to look for coverage that offers the best protection.
The Big What If Medicare Advantage
If you’re lucky enough to be healthy when you’re ready to enroll in Medicare – for most people, it’s at age 65 – the essential “what ifs” you should consider: which plan you want if you are diagnosed with cancer, or another serious illness that requires long and expensive medical attention.
If you are willing to think about this possibility, you will find that the Medicare option that looks so attractive when you are in good health (likely with no additional premium and extended coverage) becomes expensive when you actually have to use it.
Two types of health insurance
Original Medicare allows you to see any doctor and use any facility in the United States that accepts Medicare. Most do. But to get comprehensive protection with Original Medicare, it’s essential to also purchase an additional policy – called Medigap – that pays for the portion of some bills that Medicare does not pay directly.
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A Medigap policy that offers full coverage (Medigap Plan G for those of you in shopping mode) can have a monthly premium of around $ 100 to $ 300, depending on where you live. It’s not nothing. But then again, other than a basic Medicare Part B deductible ($ 203 in 2021), you’ll likely have everything covered.
Medicare Advantage is the other way you can enroll in Medicare. Most Advantage plans operate as a health maintenance organization. You are limited to a network of doctors and establishments depending on your place of residence. You also usually need prior authorization for all medical care beyond basic preventive care.
The appeal of Medicare Advantage is that you don’t need to purchase additional coverage. In fact, you are not allowed to have a Medigap policy. Not spending $ 100-300 per month on Original Medicare + Medigap is undeniably appealing. At least when you’re healthy.
But you buy insurance to protect yourself from big assumptions. And this is where Medicare Advantage might disappoint. Remember, you cannot see all doctors who accept Medicare. This means that the specialist you really want to supervise in your care may be out of reach.
The high cost of actually using Medicare Advantage
And once you start using your Advantage insurance, you’ll likely come across coinsurance that will typically require you to pay 20% of your bills. With critical illness, this can easily be a six-figure cure that charges for coinsurance.
The good news is that the government is limiting your annual reimbursable Medicare Advantage health costs. This year, the maximum amount payable is $ 7,550. Many Medicare Advantage plans set their personal expenses even lower. According to the Kaiser Family Foundation, a nonprofit health care research organization, the average disbursement this year was around $ 5,000. (There is a separate cap for prescription drug coverage.)
Illness doesn’t care about calendar years
The maximum amount of disbursements is per calendar year. Many illnesses will last at least two years, or even longer. For example, if you are diagnosed with cancer in September requiring chemotherapy, surgery, and possibly radiation therapy, you will still be the focus of treatment the following year. That means you could face the payout twice in just three, four or six months. This will likely mean having to pay over $ 10,000 out of pocket in no time. If you and your spouse both needed intensive and ongoing care at the same time, your personal expenses would double.
Original Medicare: cost and coverage
Now back to Original Medicare. It certainly costs more upfront, as it’s imperative to add a Medigap policy to cover the coinsurance costs that are built into all Medicare. Again, a premium for a Medigap Plan G (the most comprehensive option for anyone enrolling in Medicare today) can range from $ 100 to $ 300 per month, depending on where you live. But for that premium, you have no other outlay other than the standard Medicare Part B deductible ($ 203 in 2021).
If you live in an area where the costs are high, it works out to $ 3,600 per year per person. Obviously, this is a significant cost that you want to plan for. But then you don’t have to worry.
Make a lucid choice when it comes to health insurance
There is no clear right or wrong choice. The key is to make an informed choice.
Ask yourself the following question: If you develop a serious illness, will you agree with the care network, and what are the likely high reimbursable costs for at least two years, if not more?
Don’t assume you can just switch to Original Medicare + Medigap when you get sick. In most states, you won’t qualify for a Medigap policy, which will make switching impractical.
That said, if you are new to Original Medicare + Medigap and find that the premium cost of a Medigap policy is too high, you can easily upgrade to Medicare Advantage.