Medigap or Medicare Part C: What’s the Difference?

Senior Law News | Nov 22, 2019 | Letha Sgritta McDowell

There are just a few days left during this Medicare open enrollment period and, if a change is needed to your Medicare plan, then this is the time to make the change. Open enrollment is from October 15 through December 7 each year and is the time when a Medicare recipient can switch from a Medicare Advantage plan to traditional Medicare or change back to traditional Medicare and a supplement from Medicare Advantage. This is also the time period in which individuals can change their Medicare Part D plans.

While Americans are largely familiar with Medicare (it’s the health insurance plan to which we contribute our entire working lives), many are confused between traditional Medicare, Medicare supplements and Medicare Advantage Plans. Traditional Medicare includes Medicare Part A and Medicare Part B. Part A covers hospital expenses and Part B covers physician services, outpatient treatment and medical equipment. Medicare Parts A&B have both deductibles and co-pays which could amount to significant out-of-pocket costs if the enrollee has a major medical event.

Since there could be significant out-of-pocket expenses with traditional Medicare, private health insurance plans are available to cover the potential out-of-pocket expenses or coverage gaps which exist with basic Medicare. These plans are also referred to as Medigap plans. Each company offers a variety of plans at varying premium levels and which result in varying out-of-pocket costs for the enrollee. With traditional Medicare and a Medicare supplement, an enrollee should also choose a Medicare Part D plan. Part D is to portion of Medicare that insures against the costs of prescription drugs.

While Medicare coupled with a Medicare supplement is typically excellent insurance coverage, many find the out-of-pocket premium expenses to be high. An alternative is a Medicare Advantage Plan (also known as Medicare Part C). Enrolling in Medicare Advantage means that the individual actually dis-enrolls from traditional Medicare. The entire health insurance package is offered by the private health insurance plan and combines some of the coverages from Parts A & B as well as the supplemental insurance and prescription drug coverage. Medicare Advantage may also offer services or treatments which would not be covered by traditional Medicare. Because Medicare Advantage is entirely administered by private health insurance companies, plans are often limited based on geographical area and may limit the enrollee to physician groups and hospital systems. The US Government provides some funding to private health insurance companies to administer Medicare Advantage plans and for that reason, some may have little to no out-of-pocket costs monthly; however, the overall coverage may be more limited based on the plan chosen.

Both Medicare Supplement plans and Medicare Advantage plans offer combined coverage for those who are eligible. Ultimately, what plan is appropriate should be based on health concerns, lifestyle, income, and ability to pay out-of-pocket expenses in the event of an illness. There are insurance professionals who can assist in reviewing a person’s circumstances and assisting in choosing the best coverage option. For those currently unhappy in their plan, now is the time to investigate options and make changes as needed.

Ask Kit Kat: Raymond Retired

Hook Law Center: Kit Kat, what can you tell us about the mule named Raymond who lives in the Outer Banks of North Carolina?

Kit Kat: Well, I have written about Raymond before—the first time in early July of this year. He is a much beloved figure there. However, Raymond has been aging lately, especially his hooves. He’s a scrappy little fellow around the age of 20. He has wandered with the wild horses of Corolla, sometimes getting into scrapes with the stallions who dwarf him in size. Raymond never let his diminutive size deter him from doing what he wanted to do. In September, however, his hooves became worse due to navicular disease and laminitis. Meg Puckett, manager of the Corolla wild horse herd, said the decision was made to move him to Grandy, NC in nearby Currituck County, so he would not be under so much stress to forage and deal with others in the wild horse herd. Other older horses from the Corolla wild herd are there, but Raymond has his own corral. He made the move on Sep. 29, 2019. Ms. Puckett commented, “We really did not want to pull him off the beach. If we had put him back on the beach he would have died a slow and painful death. We’ve got the X-rays to prove it.”

Raymond, they report, was not exactly a model resident at first. When he spotted a male horse at a nearby stall, he started kicking, and nearly broke through his stall. When that strategy didn’t work, he tried to climb over the stall. Staff then had to put him in isolation, where he was closely monitored and fed hay and one carrot a day for several days. He has calmed down a lot, but leaving nothing to chance, they have built him a corral with thick posts, heavy gauge wire fencing, and 2 lines of electrified rope. This is in contrast to the much larger horses who peacefully reside behind a low plastic fence.

If you’d like to visit Raymond, contact the Corolla Wild Horse Farm, 102 Young Rider Lane, Grandy, NC. Occasionally, they have open houses, or they just might let you schedule a visit. (Jeff Hampton, “Raymond the mule retired from the wild and taking it easy on the farm,” The Virginian-Pilot, Nov. 11, 2019, p. 1 & 11).

Letha Sgritta McDowell

Attorney, Shareholder, CELA
757-399-7506 | 252-722-2890
[email protected]

Letha Sgritta McDowell is a Shareholder of Hook Law practicing in the areas of estate planning, elder law, special needs planning, estate and trust administration, asset protection planning, long-term care planning, personal injury settlement consulting, guardianships & conservatorships, and tax law. Ms. McDowell’s clients range from high-net-worth individuals with over $75 million in net worth to families with limited assets.

Ms. McDowell is a past President of the National Academy of Elder Law Attorneys and was named as a Fellow of the prestigious American College of Trusts and Estates Council (“ACTEC”) in 2020. She is certified as an elder law attorney by the National Elder Law Foundation (“CELA”) and Board Certified as a specialist in Elder Law by the North Carolina State Bar Board of Legal Specialization. Furthermore, McDowell is accredited to prepare and prosecute claims with the Department of Veterans Affairs.

Ms. McDowell is currently the chair of NAELA’s strategic planning committee, a member of the Board of Directors for the North Carolina Chapter of NAELA, and a member of the Board of Directors for the Purdue Center for Cancer Research. She is the former Chair of the North Carolina State Bar’s Elder Law Specialization Committee and is the former Editor-in-Chief of “Gray Matters”, the newsletter for the Elder Law Section of the North Carolina Bar Association. She is a consultant for InterActive Legal and has worked on several law and technology initiatives including IBM’s Watson project. Along with her experience practicing as an attorney, she has dedicated much of her time writing for national publications including, but not limited to: Wolters Kluwer, Wealthmanagement.com, the NAELA Journal, Trust & Estates Magazine and many more.

Practice Areas

  • Elder Law
  • Estate & Trust Administration
  • Estate Planning
  • Asset Protection Planning
  • Long-Term Care Planning
  • Special Needs Planning

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