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Medicare Advantage Plans vs Medicare Supplement Plans

There are two options commonly offered by private insurance companies used to supplement Original Medicare. The first option is called Medicare Advantage; this is an alternative way to get Original Medicare. The second option is called a Medicare Supplement (or Medigap) insurance plans. These work with Original Medicare coverage. These plans have significant differences when it comes to benefits, costs, and how the insurance carriers implement them. It's important to understand and know the differences and options as you review Medicare additional information.

 

If you're trying to decide between a Medicare Advantage (Medicare Part C) plan and a (Medigap) Medicare Supplement insurance plan, or if you're unsure of the benefits each program offers, This is a quick overview/guide of these types of plans and how they compare for your reference.

There are several different types of Medicare Advantage plans (Health Maintenance Organization) HMO, (Preferred Provider Organization)PPO, (Private Fee-for-Service)PFFS, (Special Needs Plan)SNP, (Health Maintenance Organization Point-of-Service)HMO-POS, and (Medical Savings Account) MSA. For an overview of these types of plans, see my article on Medicare Part C- (Medicare Advantage Plans).

There are also several types of Medicare Supplement policies; for more details, see my article on Medicare Supplement insurance plans. Some states sell Medicare SELECT policies. The rules of these policies are somewhat different from other Medicare Supplement insurance plans. For example, with Medicare SELECT, you generally have to choose a doctor within the plan’s network.

Medicare Advantage and Medicare Supplement insurance plans don’t work together; we don’t recommend that you try to sign up for both. In fact, you cannot be sold and use a Medigap plan if you enroll in a Medicare Advantage plan.

Here’s a chart that compares these two types of insurance (both sold by private companies).

Comparison

Medicare Advantage

Medicare Supplement

Source: medicare.gov

Eligibility

  • Must have Original Medicare, Part A, and Part B, and live in the service area.
  • Takes all applicants other than those with end-stage renal disease, except in certain circumstances.
  • You must have Original Medicare, Part A, and Part B. These plans are provided in concurrent with Original Medicare.
  • If you enroll during your Open Enrollment period, or if you qualify for guaranteed issue rights, the insurance carriers may not deny your application or charge you more if you have certain health conditions.
  • If you don't enroll during your Open Enrollment period, the insurance carriers will use medical underwriting to decide whether to accept your application and how much to charge you.
  • Generally, Open Enrollment Period begins as soon as you're enrolled in Medicare Part B and continues for six months. See medicare.gov for more information.
  • Your Medigap policy covers only you. If your spouse is 65 she will need to have her own Medigap plan. You and your spouse do not need to be on the same plan or with the same insurance carrier.
           

Costs:
( copayment, premium, coinsurance, out-of-pocket maximum)

  • Costs vary by state.
  • Typically, you pay cost-sharing (copayments) for most medical services.
  • Plans have an out-of-pocket annual maximum.
  • You still need to pay your Medicare Part B premium.
  • The premium may vary with gender and health and may go up with age.
  • The premium for the same plan will differ significantly from company to company.
  • Companies may underwrite (adjust premium based on health factors) unless you sign up during the Medigap Open Enrollment Period or you qualify for guaranteed issue rights.
  • Generally, no copayment costs for Medicare-covered services at the time of service.
  • No out-of-pocket maximum.

Provider choice and availability

  • HMOs and PPOs maintain provider networks. They must have available Medicare-assigned providers to accept new members.
  • PFFS plans have no provider network. It may be hard to find providers who accept it in some areas.
  • HMOs generally cover in-network only. Referrals usually are required for specialist visits.
  • PPOs cover out-of-network providers, but costs may be higher.
  • In PPO plans, usually referrals by your doctor aren’t required when you need to see a specialist.
  • You can go to any doctor or other health care provider that accepts Medicare assignment unless you have a Medicare SELECT plan (which might require you to choose a doctor in the plan's network).
  • Usually, referrals by your doctor aren't required when you need to see a specialist. If you have a Medicare SELECT plan, ask about their referral policy.
  • It may be hard to find providers accepting Original Medicare, Part A, and Part B, in some areas.
  • Medigap insurance may be used for treatments at major medical facilities.
  • You can generally get medical services in any state or U.S. territory (unless you have a Medicare SELECT plan).
 


Prescription drug coverage

  • If you want drug coverage, consider enrolling in a Medicare Advantage Prescription Drug plan. If your Medicare Advantage plan does not include drug coverage, you can enroll in a Medicare prescription drug plan.
  • With a PFFS plan, you may choose either the plan’s prescription drug coverage, if offered, or a stand-alone Medicare prescription drug plan.

Not included. If you want this coverage, you may want to consider enrolling in a stand-alone Medicare Part D prescription drug plan.

Is the plan renewable? Do benefits change?

Benefits can change yearly. You usually remain in a plan unless you disenroll during the Annual Election Period (AEP) or Medicare Advantage Disenrollment Period.

Medicare Advantage plans can drop doctors from their networks.

Medicare Advantage plans and Medicare Supplemental plans are guaranteed renewable as long as you pay the premium and were truthful on your application. There is No Annual Election Period (AEP) for Medigap plans. However, if you drop your Medigap plan, you might never get it again.

Extras?

  • Some Medicare Advantage plans include dental, vision
  • and hearing. Some offer an additional alternative medicine package.
  • Plans cover some of the "gaps" in Original Medicare (Part A and Part B) coverage, such as deductibles and copayments.
  • Some plans cover other services, such as medical care when traveling outside the country.

For whom it works best

  • Network plans may be useful for people who otherwise can't find a Medicare provider.
  • May save money unless you need frequent appointments or treatments.
  • Having a packaged plan may simplify choices.
  • May be useful for travelers or those with vacation homes in a different state.
  • May save money for people needing high-cost or constant care.

How to comparison shop

Medicare Advantage Plans are not standardized.

Ten types of (Medigap) Medicare

Supplement plans are standardized in 47 states; each plan is labeled with a letter (such as Plan G). Once you decide which plan you want, you can compare different insurance carriers offering the same plan. For example, if you choose Plan G, you can look at the prices that different insurance carriers might have for a Plan G. You may also want to choose a health insurer you're already comfortable with, But that is not advisable since a Plan G is the same no matter what insurance carrier you purchase it from.

 

Contact Indiana Insurance Alliance to walk thru all of your plan options and costs.

Are you tired of paying too much for your Supplement premium let us help you save money? You can change plans and carriers anytime throughout the year

Contact: Indiana Insurance Alliance

Website: www.INinsureALL.com

Phone: 765-462-6002

Email: kjones@INinsureALL.com

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