In the Huddle with “Broadway Joe”: The X’s and O’s of Medicare Coverage Options

October 28, 2021

By Brian Harmon, Director of Individual Medical at The Cason Group

If you’ve watched television at all in the past 5 years, you have probably seen a commercial with Hall of Fame Quarterback Joe Namath touting the many benefits of Medicare Advantage plans. “Get the benefits you deserve” we hear, “pay $0 for your benefits, get money back on your social security check, dental benefits, hearing, vision, gym memberships…” and the list goes on.

Because of all of these benefits, Medicare Advantage Plans have exploded in popularity. In 2021, nearly 42 percent of all Medicare-eligible beneficiaries are enrolled in a Medicare Advantage, up from 32 percent just 5 years ago. With that number expected to surpass 50 percent by 2030, it’s vital to learn how to determine if Medicare Advantage is a viable and safe option for you or your clients. Below are the three top things to consider:

Monthly premium cost.
Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Part A is normally at no cost for those that have worked 10 years or more in the U.S. and the standard Part B premium is around $148.50 monthly for average incomes (2021 average). If you want supplemental coverage such as Medigap ($120 to $130*) or prescription drug coverage (average of $38) you can add those separately. *Pricing is based on national averages and is for illustrative purposes only.

On the other hand, Medicare Advantage is an “all in one” alternative. These “bundled” plans include Part A, Part B, and usually Part D (prescription drug coverage). The average national cost for these plans is $21, and in most cases you still have to pay for Part B premium.

Out of pocket exposure for hospital visits and major procedures.
Overall, Medicare Advantage offers lower cost than Medigap and Part D. Of course, a lot of the plans can also be $0 and can reduce Part B premium obligations. However, there might be a higher out-of-pocket cost if you end up in the hospital or needing a procedure done.

Flexibility and added benefits.
You are probably aware of Medicare Advantage’s hearing, vision, dental, and even gym benefits. But in terms of flexibility, the original Medicare allows individuals to go anywhere Medicare is accepted, while with Medicare Advantage you’ll need to use doctors who are in the plan’s network.

At the end of the day, there is no “one size fits all” when it comes to Medicare. Every individual has a unique set of circumstances, and trying to determine what may happen in terms of future medical cost and unforeseen medical issues is a coin toss. But regardless of what the most popular option is, choosing the right coverage depends on your priorities — and of course, the process is way easier with the guidance of a licensed, certified, professional insurance agent.

The Cason Group is a Brokerage General Agency that works with licensed/professional agents and brokers that focus on Medicare, ACA, Group Benefits and Financial Services insurance products.