What is the difference between a Medicare Supplement and a Medicare Advantage Plan?

By planmedicare1 - March 10, 2016

If you’re eligible for Medicare, you should consider a Medicare Supplement or a Medicare Advantage Plan to help cover some of the costs that are not handled by Original Medicare. If you are unsure of which route to take, or simply do not understand the differences between an Advantage and a Supplemental plan, then look no further — Plan Medicare makes it’s easy to understand.

The first thing to know, about the difference between the two types of plans, is that Medicare Supplement plans are second to Original Medicare, while Medicare Advantage Plans are primary to original Medicare.

A Medicare Supplement Plan also known as a Medigap policy, is designed to help pay for some of the costs that Original Medicare does not cover such as copayments, coinsurance and deductibles.

Medicare Supplement Plans are uniform in the 47 U.S. states that offer them. No matter what state or insurance company, the benefits will be the same for each Supplemental plan. However, within each state the plan price can vary, depending on each insurance company, so researching your options is an important step.

Medicare Advantage Plans are run by private insurance carriers who opt out of traditional Medicare. In this type of arrangement, the private insurance carrier assumes all of the risk of the Medicare beneficiary.  A doctor or hospital must agree to accept the Terms and Conditions of a plan’s payment prior to providing healthcare services to a member (with the exception of emergencies).

Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), and Medicare Medical Savings Account Plans (MSA). The plans differ in the network of doctors available to a member, or the need for a referral to see a doctor or specialist.

Medicare advantage plans are rated each year based on the plans quality and performance. A plan can get a rating 1 through 5 (5 being the best).

Medicare Advantage plans sometime offer drug coverage in addition to the hospital and doctor coverage. The Advantage plan can combine Parts A, B, and D into one plan, resulting in one membership Medicare card.

Medicare supplement plans sold after 2006 do not include prescription drug coverage. Individuals will need to purchase a stand-alone Part D Plan, in addition to their Supplement Plan, to get prescription drug coverage. It is possible to have a different insurance carrier for a Supplement plan than your Part D prescription drug plan. A Medicare recipient may need to carry as many as three separate Medicare cards if they choose to go the route of a Supplemental Plan. (Original Medicare Card, Medicare Supplement Card, Part D Card).

Lastly, consider these important facts in switching from Original Medicare with a Supplement Plan to a Medicare Advantage Plan (Part C).

  • Advantage Plans are contracted annually. You may be limited throughout the year if you want to change benefits or costs.
  • Medicare Advantage plans are low (sometimes $0) in monthly plan premium.
  • Additional benefits not offered by original Medicare, such as dental and vision may be included in a Medicare Advantage plan.

The above information is a great synopsis of the different options, to find out which is right for you please contact us at Plan Medicare.

About Plan Medicare
Located in Melville, New York, Plan Medicare is a consulting agency formed to aid in understanding the many facets of Medicare.  Plan Medicare helps determine eligibility, clarify options and assist in the enrollment process.  Representatives are available 365 days a year to answer questions on payments, billing, policy, updates and changes and enrolling in new plans and policies. The health care landscape is constantly changing, it can be confusing and frustrating to try to figure out what kind of plan will work best.  Assistance is available, however. We make Medicare easy.

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