Original Medicare Parts A and B covers most of your basic healthcare needs. Most services leave you with 20% of the cost after paying a deductible (Medicare Part B deductible for 2024 is $240). Medicare also does not have an out-of-pocket limit either, which is means there is no limit to how much you might pay during major healthcare events.

Original Medicare also has very limited drug coverage. Almost all prescription drugs will not be paid for by basic Medicare coverage. Medicare Prescription Drug Plans (Medicare Part D) are only available through private insurance carriers who contract with Medicare to adhere to basic coverage guidelines.

As for dental, hearing, and vision, Medicare limits coverage to medical conditions that require treatment. Dental cleanings, hearing aids, and eyewear are not included with original Medicare.

While on Medicare, beneficiaries have two options to enhance their basic coverage.

Medicare Supplement (plus Prescription Drug)

The more traditional option is to choose a Medicare Supplement plan. This acts as a second insurance to your original Medicare A and B. This option will require you to pay a monthly premium, which varies depending on how much secondary coverage you want. Higher premium = more coverage. This is a good option for those willing to pay a premium to pay most, or all, of yaur healthcare expenses after Medicare pays first. If you need drug coverage, you would also need to purchase a Medicare Prescription Drug Plan to go along with this. This means you would have 3 healthcare plans (Medicare, Medicare Supplement, and Prescription Drug).

Medicare Advantage and Prescription Drug

The second option to enhance your basic Medicare is to enroll in a Medicare Advantage plan, which usually includes Prescription Drug coverage. These plans contract with Medicare to act in place of your Original Medicare benefits. They are required to provide you with coverage at least as good as Medicare, and generally include additional programs and features. This delivers the simplicity of having a single insurance plan for most, if not all, of your healthcare needs. You still pay for your Medicare Part B premium out of your Social Security check, and Medicare then pays the carrier for your Medicare Advantage plan.

Medicare Advantage plans have been growing in popularity over the past decade. With premiums as low as $0, predictable out-of-pocket costs, and added benefits like dental, vision, hearing, and fitness, retirees have been finding these options very appealing. Some may even refund you some of your Part B premium (neat, huh!?)There are many different Medicare Advantage plan options in the market to match with various needs. The caveat is that these plans typically rely on a network of doctors and hospitals to provide you with the best coverage. Seeking services from a provider who is out-of-network may leave you with higher expenses.

Can I have both?

Medicare Supplements and Medicare Advantage plans do not work together. You will need to choose one. If you are in a Medicare Supplement plan and decide to enroll in a Medicare Advantage plan, you will need to terminate your Medicare Supplement plan.

How do I choose?

Give me a call! I currently sell Medicare plans in 38 states, and plan options vary by state and county. Depending on where you live could impact what option is best for you. For instance, Medicare Advantage plans in Wisconsin, especially in the Green Bay Area, have improved significantly over the last few years. I would love the opportunity to discuss your personal needs and review plan options that are suitable for you.

Already on Medicare Supplement or Medicare Advantage

Plans change every year, and you can make changes every year as well. If you’re happy with your coverage, that’s great! It doesn’t hurt to look though. I’m happy to review what you have along with the current options, and if what you’re on is still best for you, I’ll gladly recommend you stay put.