Medicare Advantage vs. Medicare Supplement Insurance Plans

This where the fun begins

Choosing the right Medicare plan might be quite confusing so this might make everything a bit clearer for you. Original Medicare, which includes Parts A and B covers numerous healthcare related expenses, but it won’t cover all of the services you need. Even with the coverage beneficiaries will still be responsible for some deductibles and copays, which can add up quickly. In addition, Parts A and B also won’t cover certain benefits like emergency health coverage overseas, prescription drugs or even routine dental and vision needs. If you just have the Original Medicare, then you are going to be paying for these benefits out-of-pocket.

Numerous people who enroll with Medicare have two plan types that can bridge the coverage gaps. One option is named Medicare Advantage, which is another way to get your Original Medicare and the other is called Medigap or Medicare Supplement. These would work along with your current coverage under Original Medicare and these are different types of plans. It is important that you can understand the differences as you are reviewing the options for Medicare coverage.

Medicare Advantage vs. Medicare Supplement (Medigap) insurance plans

MThe Medicare supplement coverage works along with the Original Medicare, including Parts A and B that can pay for various costs that the normal coverage won’t. these aren’t stand-alone plans for coverage, but you would need to be enrolled in the Parts A and B of Medicare for your medical and hospital coverage. For those who need coverage for prescription drugs, then you need to enroll in a stand-alone plan for prescription drugs.

When you purchase a supplement insurance plan for Medicare you are still going to be enrolled in the Original Medicare, including Parts A as well as B. Medicare will pay for the health-related bills for the most part while the Medigap coverage would cover specific cost-sharing costs from Medicare, like deductibles or copays. Also, these Medigap plans might help with some other costs that your Original Medicare won’t cover, including excess charges for Part B or emergency medical coverage if you are traveling abroad. Make sure that you remember that the supplement plans can be used to cover only the costs for Original Medicare and can’t be combined with the Medicare Advantage coverage.

In contrast the Advantage plans that you can get will be another option that you can choose instead of Original Medicare. If you are enrolling in the Advantage plans, then you are still part of the Medicare program and you will just get the benefits through the Medicare Advantage coverage rather than the program that is federally administered.

To enroll in a Medicare Advantage plan, you must:

  • Have Original Medicare, Part A and Part B.
  • Live in the service area of the Medicare Advantage plan you’re considering.
  • Not have end-stage renal disease (with some exceptions).

The Medicare Advantage cover must give you the same coverage levels as the Original Medicare except when it comes to hospice care, which would be covered under Part A. There are some plans that would have additional benefits you won’t get with the Original Medicare, including routine dental and/or vision, prescription drug coverage and health wellness programs.

Medicare Supplement insurance plan benefits

Most states have 10 different insurance plans for Medigap that you can choose from and each one is designated with a different letter. Each letter has a standardized coverage that means you are going to get the same simple benefits for the Supplement coverage in each letter category regardless of who you buy from. However, no matter if the basis benefits remain the same across all insurance companies the premiums can vary based on location and insurance company. Also, keep in mind that Wisconsin, Minnesota and Massachusetts standardize the Medigap plans in a different way than the rest of the US.

The Medigap coverage will help with covering out-of-pocket expenses that aren’t covered by your Original Medicare coverage like deductibles, coinsurance and copayments. Some plans can also help for other types of benefits that aren’t covered like international emergency health coverage or the initial 3 pints of blood. This coverage won’t cover your prescription drugs and if you don’t have coverage for this, then you should look for a Part D coverage. This also doesn’t generally offer other benefits like routine vision, dental and hearing coverage more than what Original Medicare covers.

Medicare Advantage Plan Benefits

There is a bit more in terms of flexibility that the private insurance companies would have than the Original Medicare. This means that you might have quite a few differences in the plans that you are looking at, so ensure that you are comparing the plan options carefully to ensure you aren’t overlooking anything.

These plans will help you to get some coverage that the Original Medicare doesn’t offer like routine dental and vision, hearing and even health wellness programs. Normally if you are using Original Medicare, then these would be services you are paying for out-of-pocket if you don’t have any other coverage.

Another benefit for Part C of Medicare is that numerous plans also include Part D of Medicare, which covers prescription drugs. These are call Advantage Prescription Drug coverage plans and they make it easier for you to have all of the Medicare benefits taken care of through one plan.

If you have enrolled any of the Advantage prescription drug coverage plans, then you don’t need to be enrolled in any other drug plan from Medicare. You will find that if you are enrolled in an Advantage plan that has prescription drug coverage along with a stand-alone Medicare coverage for prescription drugs you might be disenrolled automatically from the Medicare Advantage coverage.

Finding Medicare providers

The Medicare Supplement coverage is widely accepted by any doctor that would accept Original Medicare. The Medicare Advantage coverage, however, might have networks that are more restricted depending on which plan you chose. Some of these would have HMO or health maintenance organization-based plans and you need to use a provider from the network to be covered. This is because the doctors and hospitals would be connected with the Medicare Advantage plan and the insurers.

There are also plans that let you use a preferred provider network so you can see both out-of-network and in-network providers. However, for this you might have higher coinsurance and copayments if you use non-network-based providers.

The situation for every individual is different and you should consider both the Medicare Advantage plan and Medigap insurance options to determine which coverage fits your requirements the best.

Medicare Advantage vs Medicare Supplement comparison chart

  Medicare Advantage Medicare Supplement
Can make changes Two open enrollment periods per year One period per lifetime unless there are special circumstances
Monthly premium As low as $0 Usually has a monthly premium
Part B deductible May not have a deductible Must pay unless you got
    Plan C or F before January 1, 2020
Must pay Must pay
Prescription drugs Generally covers Does not cover
Routine dental, routine hearing, routine vision May cover Does not cover
Networks that restrict providers Yes No
Standardized benefits No Yes
Copayments and coinsurance Usually has copayments and coinsurance May cover all copayments and coinsurance

If you have questions about which type of coverage may work better for you, contact eHealth to speak with a licensed insurance agent.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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