Medicare Advantage Is Not An Equal Alternative To A Medigap Plan.
Attached are slides comparing Medigap vs. Medicare Advantage.
Blue Cross Blue Shield of Michigan wants you to believe that Medicare Advantage plans provide health insurance that is just as good as the BCBSM Legacy plans. Of course BCBSM wants you to believe this -- they make over $10,000 more a year in revenue on an individual in an Advantage plan than a Medigap plan.[1] But BCBSM's Legacy Plan C is almost always better health coverage than a Medicare Advantage plan.
- Do you want to go to any doctor or specialist that accepts Medicare?
With a Medigap plan, you can see any doctor or specialist that accepts Medicare. With a Medicare Advantage plan, you may be restricted to a network of doctors, you may have to get a referral before you see a specialist, and/or there might be certain doctors/services that are preferred by the Medicare Advantage Plan.
- Do you want to be able to have predictable medical expenses each year?
Most Medigap plans cover 100% of your medical co-pays. With a Medicare Advantage plan, you will typically have varying co-pays that can add up. On a fixed income, paying for these co-pays can be a real burden and individuals may forgo necessary medical services. Furthermore, on a Medicare Advantage plan, you may not have a prescription drug plan that provides you with the most affordable coverage.
- Do you want to choose a prescription drug plan that best meets your individual needs?
With a Medigap plan, you can choose from dozens of different prescription drug plans to pick a plan that best meets your individual needs. With most Medicare Advantage plans, you are restricted to whatever prescriptions drugs and restrictions that plan has.
- Do you want to avoid fine print and medical bureaucracy?
Medigap plans are simple -- if Medicare pays, the Medigap plan pays according to very straightforward benefit chart. With Medicare Advantage plans, every plan is different and can change significantly each year. Furthermore, even if your doctor believes a procedure is medically necessary, the Medicare Advantage insurer may disagree and not cover the procedure. You may also have to wade through a bureaucratic maze to get the insurer's preauthorization for certain procedures.
- Do you want to be able to appeal a coverage denial to an independent entity?
With Medigap plans, you can appeal coverage denials directly to an impartial entity with independent doctors. With a Medicare Advantage plan, you may have to appeal to the insurer that has already denied your claim!
- Do you want to go on a trip elsewhere in the country and not worry about your medical coverage?
Medigap plans work the same no matter where you are in the country. With a Medicare Advantage plan, there is not a similar guarantee.
Medigap plans almost always provide better health coverage than Medicare Advantage plans. Tell your legislators to protect affordable Medigap coverage in Michigan.
Blue Cross Blue Shield of Michigan wants you to believe that Medicare Advantage plans provide health insurance that is just as good as the BCBSM Legacy plans. Of course BCBSM wants you to believe this -- they make over $10,000 more a year in revenue on an individual in an Advantage plan than a Medigap plan.[1] But BCBSM's Legacy Plan C is almost always better health coverage than a Medicare Advantage plan.
- Do you want to go to any doctor or specialist that accepts Medicare?
With a Medigap plan, you can see any doctor or specialist that accepts Medicare. With a Medicare Advantage plan, you may be restricted to a network of doctors, you may have to get a referral before you see a specialist, and/or there might be certain doctors/services that are preferred by the Medicare Advantage Plan.
- Do you want to be able to have predictable medical expenses each year?
Most Medigap plans cover 100% of your medical co-pays. With a Medicare Advantage plan, you will typically have varying co-pays that can add up. On a fixed income, paying for these co-pays can be a real burden and individuals may forgo necessary medical services. Furthermore, on a Medicare Advantage plan, you may not have a prescription drug plan that provides you with the most affordable coverage.
- Do you want to choose a prescription drug plan that best meets your individual needs?
With a Medigap plan, you can choose from dozens of different prescription drug plans to pick a plan that best meets your individual needs. With most Medicare Advantage plans, you are restricted to whatever prescriptions drugs and restrictions that plan has.
- Do you want to avoid fine print and medical bureaucracy?
Medigap plans are simple -- if Medicare pays, the Medigap plan pays according to very straightforward benefit chart. With Medicare Advantage plans, every plan is different and can change significantly each year. Furthermore, even if your doctor believes a procedure is medically necessary, the Medicare Advantage insurer may disagree and not cover the procedure. You may also have to wade through a bureaucratic maze to get the insurer's preauthorization for certain procedures.
- Do you want to be able to appeal a coverage denial to an independent entity?
With Medigap plans, you can appeal coverage denials directly to an impartial entity with independent doctors. With a Medicare Advantage plan, you may have to appeal to the insurer that has already denied your claim!
- Do you want to go on a trip elsewhere in the country and not worry about your medical coverage?
Medigap plans work the same no matter where you are in the country. With a Medicare Advantage plan, there is not a similar guarantee.
Medigap plans almost always provide better health coverage than Medicare Advantage plans. Tell your legislators to protect affordable Medigap coverage in Michigan.
[1] For Parts A & B, most Medicare Advantage plans receive at least $892/month per individual from the Federal government. The average Medicare Advantage monthly premium in Michigan is $83 and the Part D monthly premium bid amount is $85. Thus, a Michigan insurer is typically making at least $1,059/month or $12,712/year in revenue on a Medicare Advantage Plan. Even at the market rate for Medigap Plan C of $194, BCBSM only make $2,328/year in revenue or $10,000 less than a Medicare Advantage plan.
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