I’m probably more experienced with insurance than the average person, handling my own coverage as well as my husband’s and my aunt’s.
With commercial insurance, there’s typically just a few choices (such as PPO, HMO, high-deductible). With Medicare, you not only need to decide among a multitude of options, but you also need to decide between a Medicare supplement (often called Medigap) and a Medicare Advantage plan (Part C). I spoke to people with both to better understand why one would choose one over the other.
Many Americans choose a Medicare Advantage plan because it’s less expensive – often a $0 premium and sometimes offers even a credit off your Medicare Part B premium. It also offers many other benefits such as dental, vision, hearing, fitness club membership, and much, much more.
But as I have type 1 diabetes, I felt I should closely evaluate both options. The reason that a supplemental plan could be important for someone with diabetes is that, unfortunately, we’re at risk for complications and those complications can be very costly. With a Medicare Advantage plan, I’d be responsible for the 20% Medicare doesn’t cover. While those costs can most likely be tax deductible, the tax benefit is only a small portion of what you’ve paid out – IF you have at least 6.7% of your adjusted gross income (AGI) in medical expenses. That 20% can amount to a significant sum even for something less complicated like a broken arm. With a supplement plan, that 20% is covered, for the most part.
Luckily, I had a great agent – who I found when shopping for Medicare for my husband – who made sure I knew that you only have up to one year (i.e., a day before that year is up) once you go on Medicare, to choose a supplement without risking being rejected or facing higher premiums at a later point.
Working with an agent can make this so much easier – but I strongly advise everyone to work with an independent agent who can shop at different companies versus contacting a particular insurer and looking at only their insurance plans. The agent has access to many insurers’ databases, can check whether your providers are in their network, and can also calculate costs for your prescriptions to help you further compare. Because of this, I didn’t need to look at each plan and try to look at the tiers to calculate what cost would be relevant for my various insulins and other prescriptions.
For anyone wanting to compare the cost of a Medicare Advantage plan with a supplement plan, I’d suggest making a list of the various doctor visits and services you have in a typical year and then calculating the cost of those under each of those plans.
One challenge was finding out which brand of diabetes supplies was covered by a plan. An insurance company told me I had to contact their medical device supplier, but getting the name of that supplier (or suppliers) was not easy. Then, once I finally reached the supplier, I was told they couldn’t tell me because I was not yet a plan participant. This is where working with an insurance agent is helpful, as my agent was often able to get that information for me.
I chose to try Medicare Advantage for the first 364 days, as I’m in great health, and then I switched to the supplement to be able to compare. I’m still on the supplement in my third year of Medicare.
One factor that may not be relevant for everyone, but was an important consideration for me, was medical coverage outside the U.S. as I like to travel. While the particular Medicare Advantage plan I looked at had better coverage than the supplemental plan, my agent was able to get a rider for the supplement for that and other benefits. So it’s key to ask about all the types of riders that might be available. Having said that, travel insurance that includes health coverage can also be purchased.
One big advantage Medicare coverage has over commercial insurance is the $35 cap on insulin, but maintaining eligibility for coverage for a continuous glucose monitor (CGM) is a lot of work. This is unfortunate when those of us with diabetes already are spending an inordinate amount of time managing our disease. So it’s really important to know that, for example:
Again, my best advice is to find an agent who can help you navigate this complicated system.
