Medicare Solutions

Medicare can be confusing, but at ETA Benefits Group, we work with you every step of the way to make the selection and enrollment process as simple as possible. We work with a number of carriers and can help you choose the plan that’s best for you.

Before choosing a plan, we want to be sure you know the difference between your many options; particularly how Medicare Supplements and Medicare Advantage Plans differ. Many people sign up for Advantage Plans thinking they are Supplements; they are not.

Medicare Supplement

A Medicare Supplement is used with original Medicare. Any caregiver that accepts Medicare will take a Supplement because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Supplements do not include Prescription Drug Coverage (Part D, PDP. For those that do not get a PDP when first eligible, there will be a penalty when they do get a PDP (although there are exceptions). Although the cost generally goes up, the coverage provided by a Medicare Supplement does not change from year to year.

   

Medicare Advantage

A Medicare Advantage plan works differently than a Supplement. With a Medicare Advantage Plan, a private company takes over for Medicare (you remain in the system but Medicare is no longer responsible for your bills). These plans follow the same type of module as many group plans such as HMO or PPO. With this type of plan it is important to remember several things:

  

    1. Most Advantage Plans have networks, so you want to make sure your doctor, hospital, and auxiliary care are within the network (otherwise you will be paying higher costs, and in some cases, you are responsible for 100% of care outside the network).

    2. Advantage Plans have co-pays associated with them. It is important to be aware of this because co-pays can add up to quite a bit of money.

    3. Most Advantage Plans have the Part D “built in”, which is a nice bonus, but you must be aware that when switching to a Supplement from an Advantage Plan you will also need to add a Part D. There are several types of Advantage Plans that do not have the Part D built in, so keep this in mind when choosing any plan).

    4. Advantage Plans typically have value-added benefits. They vary between plans but typical benefits include health club membership, limited dental, eye and/or vision.

Also, not all Plan D’s are the same. Although they are required to be at least as good as the Medicare model, they can vary greatly in costs, co-pays and coverage for specific drugs. It is important to weigh your options and choose which one is best for you and continue to check each year because like Advantage Plans, they change every year.

Because these plans vary even from one county to another, we strongly recommend that you talk to an independent insurance agent to help you choose the one that best suits your needs.

 
     
 

All Rights Reserved ETA Benefits Group

Provides Personal Insurance, Business Insurance, Indvidual Life / Health Insurance, and Group Benefits to All of Pennsylvania, Including Nesquehoning, Tamaqua, Jim Thorpe, Palmerton, Pottsville, Hazleton, Allentown, Schuylkill Haven, Weatherly, and Lake Harmony.