Step 4 of the Path

Medicare Plan Descriptions

Plan G, Plan N, Plan F, and Medicare Advantage. What each one covers, and who each one suits.

First, the Basics

What a Supplement Is Supplementing

At age 65, Medicare becomes your basic health insurance coverage. There are two essential parts to Medicare, Part A and Part B.

Part A covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice, and some home health care.
Part B covers doctor visits, outpatient care, laboratory work, diagnostic tests, surgery, durable medical equipment, and preventive services.

With Medicare there are gaps in coverage: deductibles and coinsurance. These are costs you pay yourself if you do not have supplemental insurance, and some of them can be very large. Supplement plans for Medicare act like an umbrella, protecting you from those gaps by paying those extra costs for you.

Remember the 80/20 formula for Part B. After the annual Part B deductible, Medicare pays 80 percent of the Medicare approved amount and the remaining 20 percent is yours. A supplement pays that 20 percent for you. On a large claim, 20 percent is not a small number. Most preventive services and most laboratory work are covered in full, outside that split.

A note on dollar figures. The Part B deductible and the Part B premium are set by Medicare and change from year to year. Rather than print a number here that may already be out of date, we confirm the current figures with you at your appointment. What matters for choosing a plan is the structure, and the structure does not change.

One more thing to know up front: with Original Medicare, prescription drugs are separate from regular medical costs. You buy a Part D prescription drug plan on your own. With most Medicare Advantage plans, drug coverage is built in. A few kinds do not include it, such as Medical Savings Account plans and some Private Fee-for-Service plans, and with those you still need a stand-alone Part D plan. We check this on any plan before you enroll.

The Four Plans

Four Plans, Four Pages

Each plan has its own page in this path. Read them in order, or go straight to the one you are weighing.

Plan G

The richest Medicare Supplement available to anyone who became eligible for Medicare on or after January 1 2020. After the annual Part B deductible, it pays your share of Medicare approved costs in full.

Read about Plan G

Plan N

Nearly identical coverage to Plan G at a somewhat lower premium, in exchange for small copays at the point of care and responsibility for Part B excess charges.

Read about Plan N

Plan F

The only plan that covers every gap Medicare leaves, including the Part B deductible. Closed to people newly eligible for Medicare on or after January 1 2020, and kept for a lifetime by those who already hold it.

Read about Plan F

Advantage Plan

A single private plan that bundles Part A, Part B and usually Part D together. Lower monthly premiums, a network to stay inside, and copays as you use care.

Read about Advantage Plan

Side by Side

Medicare Supplement or Medicare Advantage?

Six things to weigh. Read down the list and you will usually know within a couple of minutes which side you are on.

Consider	Medicare Supplement	Medicare Advantage
Budget	Works when the supplement premium fits comfortably in your budget. Premiums are the trade for near zero out of pocket cost.	Works when a supplement premium does not fit comfortably. Monthly premiums are lower, sometimes zero.
Choice of doctor	Any doctor or hospital in the country that accepts Medicare. No network to check.	Limited to the plan network. An HMO limits you to one medical group and its network hospital. A PPO has a larger network and lets you go outside it for a higher copay.
Prescriptions	You buy a separate Part D prescription drug plan.	A prescription drug plan is included with most Advantage plans. A few kinds do not include one, so we check before you enroll.
Out of pocket risk	The supplement pays your share of Medicare approved bills after the Part B deductible, for a lifetime. Care Medicare does not cover, such as dental, vision, hearing aids and long term care, is still yours.	You pay copays as you use care, up to an annual out of pocket maximum. Hospital stays and certain procedures carry their own copays or coinsurance.
Stability	The benefits in each lettered plan are set by law and do not change, and the company cannot drop you as long as you pay the premium. You can keep your plan for a lifetime. Premiums do rise over time, and Congress can change which plans are sold to new enrollees, which is what closed Plan F in 2020.	Every year the insurance company can make small changes to copays and benefits.
Insurability	If the supplement becomes too expensive later, you can move to an Advantage plan in any Annual Open Enrollment, October 15 to December 7, and in some situations, such as a move out of the area or losing other coverage, at other times of year too.	Returning to a Medicare Supplement later can require answering medical questions, and the request can be declined for a pre existing condition. Two exceptions matter. If this is the first time you have ever joined an Advantage plan and you dropped a supplement to do it, you have a 12 month trial right to get that policy back with no health questions. And in California the Birthday Rule gives you 60 days after your birthday each year to move between supplements of equal or lesser benefits without underwriting.

Not sure? It may be best to think about it for a year. You can enroll in an Advantage plan every year during the Annual Open Enrollment, October 15 to December 7. And if you are already in an Advantage plan, you get a second window, January 1 to March 31, to switch to a different Advantage plan or return to Original Medicare.

Which Plan Is Right for You?

In one hour we go through every option available to you here on the Central Coast. There is never a charge for our services.

Schedule an Appointment Call (805) 966-4900