I don't understand how my friend pays nothing for their plan and I pay over $200-are these plans just totally random by ZIP code?
Answered by 22 licensed agents
The plans are not random. If your friend pays nothing for his Medicare plan, this is highly likely to be a Medicare Advantage plan featuring deductibles, copays and coinsurance depending on the plan. Most advantage plans feature a $ 0-dollar copay to see your primary doctor but will have a $30-to-$ 50 dollar copay to see a specialist and there will be additional costs depending on what's going on. Now if you are paying over $ 200 for your plan, you may have a very high-benefit Advantage plan but it is more likely that you have a Medicare supplement plan and this is a different animal. Medicare supplement plan F pays after Medicare leaving you with no medical bills for health services for Medicare-approved services (or no bills after a 2025 $ 256 outpatient deductible if you have a supplement Plan G). Talk to your independent insurance agent about all this otherwise get your license and help me explain this stuff!
No. Plans are not random by zip code. Without further information, it seems you may have a Medigap plan with a monthly premium and your friend has a Medicare Advantage plan with NO monthly premium.
Medicare Supplement and Medicare Advantage are 2 different products. Perhaps she has an Advantage Plan, and you have a Supplement Plan. That said, read on about reimbursement rates.
Congress established a formula for reimbursement to each county based on Medicare fee-for-service per capita costs, MA risk score trends, effective growth rates, etc. In other words, it's an extremely complicated formula. These rates are adjusted annually.
As a Medicare agent, what I observe is that denser populated counties have richer benefits and a greater selection of plans to choose from. For example, there are 115 different Medicare Advantage plans in Los Angeles County, CA. Yolo County, CA, has 33.
Being aware of this situation helps temper expectations when your friend tells you everything is a zero-dollar co-pay when you have a deductible and high co-pays in your plan.
There are many types of plans out there, and generally, you may pay more for better insurance. You most likely have what is called a Medicare Supplement, which is a Private Insurance that is designed to pay on top of Original Medicare. It gives you the freedom to go anywhere (no networks to be concerned with) because Original Medicare is your primary payor, and your supplement pays secondly and helps pay your health bills. It could be your friend could have Medicaid, or possibly enrolled onto a Medicare Advantage plan. Those plans work differently than a Medicare Supplement plan.
Medicare plans are available based upon zip code but there are many types of plans available. Basically, there are three type of products that people can enroll in addition to Original Medicare. The three type of plans that are available are Medicare Supplement plans (also referred to as Medigap plans), Prescription Drug Plans, and Medicare Advantage Prescription Drug plans. Medicare Supplement plans do carry a premium whereas some Medicare Advantage Prescription Drug Plans may not carry a premium. Most likely, you are enrolled in a Medicare Supplement and your friend is enrolled in a Medicare Advantage Prescription Drug plan. It is, however, quite possible to be enrolled in a Medicare Advantage Prescription Drug plan that does carry a high premium. In order to best understand what coverage you have always reach out to a local broker for a quick review. Lastly, it is also possible to be enrolled in a zero premium Prescription Drug plan or a plan with a very high premium. Always check your cards and always reach out to a local broker for assistance.
Yes the counties zip codes states and plan selected couls affect the outcome of the premium. So all that needs to be looked at when enrolling in a plan.
This is something that I hear all the time. Typically, it is because your friend does actually “pay something.” More than likely, they pay their Medicare part B premium out of their Social Security check, which feels like “nothing” because they do not see it. Then, they may have a Medicare advantage plan that has a $0 per month premium. Whereas you more than likely have a Medicare supplement plan where you pay a premium every month out of your checking account. To your friend, it seems as if they “pay nothing” while you are paying a premium every month. The reality is both of you pay a premium for Medicare part B and they have a zero premium Medicare advantage plan and you have a monthly Medicare supplement premium.
In the end, everyone pays something regardless of which type of plan that they have. It all comes down to HOW you want to pay for it.
You likely decided to acquire a Med. Supplement (Medigap) at a monthly premium. Your friend applied for a free Advantage plan which is subsidized by the Federal Govt. The trade-off is that your friend is responsible for a steep deductible (anywhere from $2,600.00 per year thru as much as $10,000.00!). Choosing among those options are not easy. It had to do with your health issues if any, your family history of longevity, the Rx's you have been prescribed and naturally, your finances. If you interview only one agent, he/she may have been a “captive agent”, meaning that they only represent one company. But if you see the requisite 2-3 agents when turning age 65, you will have a variety of plans to pick from. Your zip code only matters if you chose an Advantage plan whereas the Supplement is universally accepted in every State of the Union.
Sound like you have 2 different types of plans. However, Medicare advantage plans for the most part, but not all have a $0 premium and a large out of pocket maximum. Plans vary by area usually counties and basically base the plans on the amount of $ they received from CMS for that area (SMS capitation rate)
In Maryland ZIP CODES mean nothing as elates to Plan Options because zip codes cross County and City boundaries. In fact when speaking with friends or relatives yo can never compare what they pay with what you pay unless you see the same Doctors, take the same Prescriptions, use the same Pharmacies, have the same health issues, and have the same "risk level" and budget for your Health Care Plan.
Health Care is unique to every individual and even a Husband and Wife may have different needs and therefore different Plans.
Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
The best way to discuss that is to sit down and look at what your plan is. If your friend is comfortable, I’m happy to look at her cards and tell you the difference between the two plans. There are so many plans out there. It’s hard to say
First you may not be comparing apples to apples; without knowing their income, plan details, etc, you are likely not comparing like plans. Some states allow “rating” insurance by zip codes, others gender, tobacco use, and age. Some use all of these. Agent’s can sort the details and risks making sure you needs are being met.
It sounds like your friend has a Medicare advantage plan, and it sounds like you’re paying for a Medicare supplement plan. Most Medicare advantage plans cost nothing. But have more out-of-pocket expenses. Where a supplement yes you’re paying a monthly premium, but hardly get any medical bills in the mail.
Hello, your friend likely is on a Medicare Advantage plan also called part C Medicare. These types of plans are in the form of HMO PPO Etc.
For you it sounds like you are on a Medicare Supplement Plan also called a Medigap policy. A Medicare Supplement Plan gives you more Network flexibility as long as the provider accepts Medicare assignment. And yes, you pay a premium for those plans to have that flexibility as well as, in most cases, no copays or coinsurance.
They are both viable options depending on your needs.
Plans, depending on exactly what plan you're talking about, are priced based on your zip code, your age, your sex, and then discounted based on your income level.
More than likely you have a Medicare Supplement plan and your friend has a Medicare Advantage plan. Medicare supplement plans require a monthly premium, whereas a very large majority of Medicare Advantage plans are offered at a zero - $0-dollar monthly premium. In addition, Medicare supplement plans also require purchasing a stand-alone prescription drug plan where most Medicare advantage plans combine the prescription drug portion all into one plan.
I doubt you and your friend have the same plan if that is the cost diffrence. Plans are priced by county not zip code so everyone in the same county will have the same cost for the same plan. A neighboring county could be more or less for the same plan.
It is quite possible that you could have a Medicare Supplement (also known as Medi-gap policy) in addition to your Medicare (there are several different companies that offer a supplement to Medicare). A supplement helps pay for the deductibles and coinsurances Medicare doesn't cover.
It is also possible your friend may have a Medicare advantage plan, those typically have a low to no cost premium and combine your Parts A, B, and D up into one plan (also known as Part C). The Medicare advantage plan benefits, costs, and availability are based on zip code.
Yes, your zip code definitely matters but I wouldn't use the word "random". There are two different Medicare plan options and from your question, you and your friend have two different Medicare options. Plans that are $0 premium are nice but you will get bills and/or have to pay copays for doctor visits, ER, ambulance, etc. If you're paying a high monthly premium of $200/month, you likely don't pay copays or get bills; paying your monthly premium takes care of most or all of your medical expenses. Talking with a licensed Medicare broker/independent agent will be key to help you understand the different options, the pros and cons of each option, and ultimately deciding which option is the best fit for you personally.
That’s a great question, and you’re not alone—lots of people wonder the same thing!
Plans can seem totally random, but there are a few reasons your friend might be paying nothing while you’re paying over $200:
1. Location matters. Insurance companies offer different plans based on ZIP code. Some areas just have better deals than others.
2. They might get extra help. If your friend qualifies for Medicaid or other programs, their costs could be much lower—even $0.
3. Different plan choices. Your friend might’ve picked a plan with fewer extras or a smaller network, while yours may include more coverage or more doctors.
4. Companies compete differently. Some insurance companies offer really low-cost plans in one area but charge more in another.
It is likely that your friend has a Medicare Advantage plan and that you have a Medicare Supplement plan and a Stand-Alone Prescription Drug plan.
Many Medicare Advantage plans have a $0 dollar premium as the insurance companies are paid by Medicare. The Advantage plans and options do vary, based on the county that you live in.
