_e world of Medicare is quite complex, but most seniors find themselves in one of two scenarios, either covered by original Medicare (A & B) with a Medicare Supplement, or by a Medicare Advantage Plan. Each plan has unique benefits and challenges, and understanding the differences is vital to make sure your coverage meets your needs.
Medicare Advantage: Advantage plan premiums are either very low or non-existent, making them an incredibly popular option. Because premiums are so low, the cost of using the plan is usually much higher. Seniors who are generally healthy and don’t use their plans often can come out on top, but things like MRI’s, CT scans, hospital stays, and durable medical equipment can be very expensive. On specific services like those I just listed, your cost is normally a copay or coinsurance. As the cost of healthcare increases, we’ll begin to see Advantage plans reduce benefits across the board. _ere is no hiding from inflation in this market.
_e high costs can be daunting, but the “useability” of the plan is what seniors find even more challenging. Most Medicare Advantage plans have networks that you must use. You cannot simply call the specialist a friend recommended. _e process, which can be frustratingly slow, starts with you reaching out to your primary care provider and working through them.
Another challenge associated with Advantage plans is “prior authorization,” which means the plan decides if your procedure is allowed and whether they will pay for it. _is has been such an issue that regulatory agencies have stepped in to expedite the decision-making process starting in 2026. In the meantime, many seniors who are navigating serious health concerns are being forced to file appeals.
Medicare Supplement: Seniors who carry a supplement plan are primarily covered by Medicare. _e “supplement” sits on top and covers the remaining 20% Medicare doesn’t cover. Supplement plans are very user-friendly; seniors may see any medical provider in the country who accepts Medicare, no referrals or prior authorization needed. _e catch? Higher monthly premiums. Supplement plans are priced competitively upon enrollment, but due to aging and inflation, prices increase over time. If you have substantial health changes, it may be di_cult to change your coverage to save money. We specialize in this so feel free to reach out.
Each plan has benefits and challenges to navigate. As your Medicare insurance broker, my goal is to help you decide which plan is best suited to your unique situation. Visit us at 2604 Long Prairie Road in Flower Mound or call 800-750-2407 for a personal evaluation!
God Bless.
Tim Bergeron is the Director of Operations at Plan Medigap – Fully independent Medicare Agency
