To the editor:
This letter is to help all of the people who are unsure how to navigate when it is time to sign up for Medicare. Medicare pays 80% of all your medical costs, with a once yearly premium of $185.50. You are responsible for the other 20% of your coverage. Thus, the need for insurance to cover this 20%. Medicare was not originally set up this way, but years ago the Health Insurance lobbyists fought to get back a portion of the coverage needs from seniors, worried about loss of money once people met retirement age. So now we are given a choice between two types of programs, the Medigap programs, or the Medicare Advantage programs.
Medicare, with a Medigap supplement, allows a person to remain under the “roof” of the Medicare regulations of coverage. Medicare rules of coverage allow you to choose your own doctor, do not require pre-authorization of care and maintain your coverage no matter the illness you have. If you end up with a deadly diagnosis, your treatment will be covered, where ever you choose to go. This is important, as the Medigap plan you choose remains under the rules of your actual Medicare, your Medicare rights never change. There is no “network” you are obliged to stay under.
In a Medicare Advantage program you are no longer under the “roof” of Medicare. Yes, Medicare still pays the 80% of your coverage, but the advantage plans have their own rules you must follow. Unlike Medicare/Medigap, the Advantage programs rules keep clients in their network, you can only choose doctors in network, you need pre-authorization for care. Medicare regulations no longer apply; you are at the mercy of the Ins. Company’s plan, their network. The media is flooded with advertising to encourage you to choose these plans, offering extra things, like dental and gym memberships. But if you find yourself with a diagnosis that is costly and debilitating, advantage plans can refuse your treatment as “claim not covered.” You are now at the mercy of this plan, and they make up the rules. People have even been cut off of coverage with a diagnosis like cancer, etc. Medicare/Medigap will not do that to you. Advantage plans are quite like “privatizing” your Medicare. Be aware. Learn the rules of Medicare and stick with programs that keep your under the “roof” of Medicare regulations.