Medicare Advantage (part C) vs. Medicare Supplement (Medigap)
Local Health Insurance Agent agent Shelly Rogers with Nevada Insurance Enrollment has been flooded with questions from her customers about the differences between Medicare Advantage and Medicare Supplement plans.
She explains “During The Medicare Annual Election Period (AEP), which is from October 15th through December 7th each year, many people may ask the question “Do I want a Medicare Advantage Plan or a Medicare Supplement Plan (Medigap)?” To help someone answer that question, they have to know the differences between these two different programs to make a good decision.”
Medicare Advantage Plan (Part C)
Shelly states “Many Medicare Advantage plans have “Part D” which is prescription coverage built into the plan. A persons prescriptions are covered with these type of plans called Medicare Advantage Prescription Drug (MAPD).
Some Medicare Advantage plans have a $0 premium, some have a small premium. Medicare beneficiaries could still have out of pocket expenses like “co-pays“, “deductibles“ and may have other costs. Some MAPD plans are HMO while others are PPO. They generally will have a “Network” of doctors and hospitals.
Do you want a Medicare Advantage Plan or a Medicare Supplement Plan (Medigap)?
If someone has Medicare Part A and Part B, they cannot be turned down (unless they have End Stage Renal Disease) for a Medicare Advantage plan. They must live inside the insurance plan’s “service area”. Many plans will require their members to select a primary doctor that is charged with overseeing care for that individual.
If a person enrolls into a MAPD plan, their claims are paid by a private insurance company instead of original Medicare. They’ll use their private insurance company’s health card, not their Medicare card when they see their doctors.
Each year the health insurance company offering the Medicare Advantage plan can renew their plans, or can terminate their plans. It is a year to year contract. Medicare Advantage (MA) is a type of health insurance offered by private insurance companies that have been approved by Medicare and are referred to as “Medicare Part C”. These plans are required to offer the same or better benefits as Medicare, but can offer additional benefits too.
Compare Medicare Advantage to:
Medicare Supplement (Medigap)
She explains “With a Medicare Supplement Plan F, a person won’t have co-pays or deductibles. They only have their premium to worry about each month, keeping their medical expenses predictable. No surprises with medical expenses like copays or deductibles.
Medicare Supplement (Medigap) is private health insurance. It sits on top of Medicare to supplement it. It fills in the “Gaps” of original Medicare. Medicare Supplement plans have a premium associated with them.
A person can choose their own doctors and hospitals that accept Medicare without having to worry about “Networks” or “Referrals”. They can travel anywhere in the country and be covered by seeing any doctor that accepts Medicare.
They can purchase a Medicare Supplement plan (Medigap) any time of the year. The Medicare Supplement plans don’t have certain times of the year when people enroll. They will, however, after they’ve had their Medicare Part B plan for 6 months, need to go through some “Underwriting” questions to see if they can be approved. The first 6 months they’ve had Medicare Part B, a person cannot be turned down.
Insurance companies can charge different rates for the exact same Medicare Supplement plan, so it makes sense to shop prices. A Medicare Supplement Plan F with insurance company A will have the exact same benefits for a Supplement Plan F with insurance company B. So shop around and get the best price.
Medicare Supplement plans generally require a separately purchased prescription drug plan. This is important. You’ll pay a penalty if you go without a qualified drug plan.
Please Note: It’s important to understand that a person cannot have a Medicare Advantage plan and a Medicare Supplement plan at the same time.
Let’s Compare. Keeping in mind that Medicare Advantage (Part C) and Medicare Supplement plans are NOT the same thing. They are very different.
Many people love the idea of having a Medicare Advantage (Part C) plan because it has a minimal monthly premium. The MAPD plans have prescription coverage built into the plan so you don’t have to buy a separate drug plan. Many MAPD plans also have added benefits like dental and vision coverage, transportation, gym memberships, etc.
You need to consider however, the costs of one trip to the hospital, or co-pays for doctors, or to see a specialist. What is the co-pay to have an MRI done or a medical procedure? You can’t always calculate or predict these expenses. Many customers have told us that they avoid going to the doctor, having tests run, or going to the hospital because their Medicare Advantage Plan (Part C) has co-pays or deductibles. They just treat themselves with home remedies instead of being seen by qualified professionals. If you don’t want to worry about that, a Medicare Supplement Plan F may be for you.
With a Medicare Supplement Plan F, you would pay your monthly premium and that’s it. No co-pays, deductibles, co-insurance, etc. You just pay your monthly premium and see any doctor in the country that takes Medicare. Your monthly costs are always the same, and that can really be a benefit for folks on a strict budget. You’ll need a prescription drug plan purchased separately.
Would you like to have constant and predictable medical expenses?
A Medicare Supplement plan may be for you.
Medicare Advantage vs. Medicare Supplement Common Questions
This chart shows some common questions asked when comparing Medicare Advantage to Medicare Supplement plans.
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