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Health & Fitness

Deciding Whether You Need a Private or Public Medicare Supplement?

dennis byron, Neighbor

In order to decide what decision to make as part of the annual Part C/Part D enrollment period ... or to decide not to do anything and leave things the way they are this year... it is important to remember why you bought the supplemental insurance in the first place. Then 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. Private vs. public? It don't matter!

If you are on Medicare and under 70 (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 accepted 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 when you worked, it's like the old Aetna (or Cigna or Prudential or...) vs the local HMO choice (Fallon or Fallon or...). It's like that but not exactly the same so 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 another 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.

The views expressed in this post are the author's own. Want to post on Patch?

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