Last article (Oct. 25 edition of Up and Coming Weekly), I covered Medicare parts A and B and how the pitfall to the unwary is the lack of a maximum out of pocket. There are two ways to address this problem: Supplements and Medicare Advantage. The rules vary between states so I will only cover North Carolina rules.

Gertrude Stein said, “A rose is a rose is a rose” and the same can be said of a Medicare Supplement. Supplements are state regulated. The state decides which plans can be sold and the benefits do not vary between companies. No matter the source of your plan, the benefits remain the same.

A Plan G is a Plan G is a Plan G. Carriers only decide the premium and underwriting questions. Typically, the lower the premium, the more stringent the underwriting questions. Medicare Supplements, commonly called Medigap, are only guaranteed issue after age 65 and for the first six months of eligibility for Part B.

A supplement is filed in addition to Original Medicare and picks up the co-pays and charges left over. Which co-pays and charges depend on the letter of the plan. Plan G is the most comprehensive, only leaving the Part B deductible unpaid.

Supplement pros: no network — Providers accepting Medicare accept the Supplement, known costs are already calculated for the year, and it can be freely used while traveling inside the US.

Supplement cons: Expensive and price increases with age, no prescription drug coverage so it requires a drug card, does not cover dental, hearing, or vision, and it isn't a guaranteed issue outside the initial window which may preclude some people.

If you are on medicare due to disability, the premium skyrockets. As an aside, Blue Cross Blue Shield has a Blue to Blue program allowing clients to switch plans without underwriting.

Medicare Advantage isn’t filed like a supplement additionally to Original Medicare. It is filed in lieu of Original Medicare. Advantage plans are cheap and typically cover prescription drugs. There are many beneficial inducements offered with these plans.

MA pros: Guaranteed issue, cheap, most offer hearing, vision, and dental benefits as well as quarterly over the counter benefits. Some offer transportation, home service, gym memberships, and part B buybacks. Low co-pays, low maximum out of pocket, and no deductible are generally staples.

MA cons: Networks, remember Cape Fear Valley’s situation, and formularies are the two major things to pay firm attention to. Make certain all your providers and prescription drugs are covered or have suitable substitutes.

These plans can change by county and zip code so the plan your friend has might not be available to you. Benefits fluctuate annually and a good plan this year may be bad the next.

Travel is possible but requires calling your carrier for approved providers in your intended destination. When done well, by a professional, they are great. When done wrong, they are a nightmare.

This open enrollment, try to make an educated decision with a professional’s help. If you need one, I know a guy.