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Health & Fitness

Seniors: How to Choose a Private vs. a Public Medicare Supplement

dennis byron, Neighbor
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The first major decision you face on the Medicare decision tree (page 16 of the "Medicare and You, 2014" booklet):

  • Private Medigap supplement (left hand side of the tree) or 
  • Public Part C Medicare Advantage health plan (right hand side of the tree)
The first thing you need to know is that all the propaganda in the country about private vs. public is pure politics.  Fuggettah abouddit! All Parts of Medicare -- including private Medigap plans -- are highly regulated by the government (see Note). All Parts of Medicare are administered by private insurance companies. It don't matter!

If you are on Medicare and under 70 for sure (probably even if you are under 75) this choice is the same one that you faced every year at work. The major differences from your point of view are:
  • Medigap plans are accepted by any provider that accepts Medicare (which is almost all for the reasons explained here under point 4), anywhere in the country (but not usually outside the country -- even in an emergency -- unless it specifically says so)
  • Part C Medicare Advantage plans are typically accpepted only by providers in a network in your region (but sometimes you can use it anywhere and pay a much higher co-pay and you are always protected in the country in case of an emergency)
In other words, remembering back to open enrollment at your job, it's the old Aetna vs the local HMO choice (but not exactly). The key questions to ask are:
  • If you have a favorite doctor or hospital, does it accept any Part C plans? If not, that makes the decision for you.
  • If you spend a lot of time away from your legal residence each year, do you need to be able to go to the doctor at the other place on a regular basis (remember: emergencies are covered either way)?
Of course, this is the government. There are some other little nits to look at. More to come on my next blog post.

Note: In the case of private Medigap plans, they are regulated by both the Federal and state government. In Massachusetts, it's the Department of Insurance.
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