Seniors: More on Choosing A Private vs A Public Medicare Supplement

• Does your doctor take Part C?
• Do you stay on the Cape all year except for a couple of weeks vacation?

There are more details on the October 26 post but if the answer to either of those questions is "No," you probably want to go the private Medigap route (lefthand side of the decision tree on page 16 of the "Medicare and You, 2014" booklet)

But naturally there's a little more to it. This is the government, which is not noted for simplicity.

From the insurance company's point of view, the difference between the two is the difference between fee for service insurance vs. capitated insurance. In English, that means the government contractor insurance company that is running your Medicare policy, depending on the one you choose, is either going to pay your providers a lump sum for the year or a fee every time you go see a provider.

But from your point of view the major difference is whether you want to be part of -- and somewhat limited by -- a coordinated network of providers (public Part C) or whether you want to be able to choose any provider you want at any time (private Medigap insurance). That's why a private Medigap plan is probably going to be your choice if you spend a lot of time off Cape.

In making that the decision, you need to look at actual costs and likely costs. Public Part C Medicare health plans are usually less expensive (the trade off for staying within the network) than private Medigap plans but they do have co-pays every time you go to the doctors or into a hospital or surgical center. You have to figure out if you think -- in your case -- whether the co-pays are going to add up to more than you would have paid in higher Medigap premiums.  But -- like Original Medicare Parts A and B -- Medigap does not cover a lot of things at all so you need to include in a cost analysis some of the extras that might be in your Part C plan like one or two teeth cleanings a year, or an annual physical or the usually built in drug plan (with a private Medigap plan you will most likely also want to get a Part D Medicare standalone prescription drug plan).

And that's the final little extra gotcha in deciding between a private Medigap supplement or a public Part C supplement: make sure the Part C you are interested in covers your drugs and at a reasonable co-pay.