Medicare Advantage vs Medicare Supplement

You are here:

Knowing the differences between Medicare Advantage and Medicare Supplements is crucial regarding your healthcare coverage benefits.

If you’re signing up for Medicare; you must decide whether a supplemental insurance policy or Medicare Part C Advantage Plan will benefit you the most.

The names and letters can be confusing. It’s important to understand the differences between these plans before you sign up. When you are confident in your insurance coverage, you will be confident in your health care.

Differences Between Medicare Advantage vs Medigap

Medicare was established in the 1960s, Medicare Part A offers hospital coverage and Part B covers outpatient expenses. Traditional Medicare pays 80 percent of medical costs after the deductible is met.

To avoid paying thousands of dollars out of pocket, beneficiaries buy supplemental insurance that covers things that Medicare doesn’t.

In 2003, Congress established the Medicare Advantage program. Thus, allowing private insurance companies to offer Parts A and B coverage as an alternative to Original Medicare

Medicare Advantage plans are considered Medicare Part C. These plans may offer more extensive coverage than Original Medicare. However, if you have a Medicare Advantage plan, you can’t have a supplement plan, you’ll need to select one.

medicare advantage vs medigap

Key Features of Medicare Advantage Plans

Medicare Advantage plans replace Medicare Parts A and B coverage and may also offer additional coverage. You’ll need to continue paying your Part A and B premium in addition to the Part C premium.

Most beneficiaries don’t have a Medicare Part A premium.

Like most employer-sponsored health insurance, Medicare Advantage plans have provider networks, and you’ll pay more if you use out of network doctors, hospitals or DME suppliers.

Most plans include prescription drug coverage. If they don’t, you can sign up for a standalone Medicare Part D prescription plan. If you don’t purchase drug coverage when first eligible, you’ll need to pay the Part D late enrollment penalty.

There are a variety of plans available. All offer at least the same basic coverage as Original Medicare. There may be a wide range of premium prices, deductibles, and co-pays, but some coverage is better than no coverage.

Some plans, in some areas, may include vision, hearing, or dental coverage. However, routine coverage is generally all that is offered, so don’t expect denture coverage through Part C.

The Key Features of Medicare Supplement Plans

Medicare Supplement plans to provide insurance coverage to fill the holes of Traditional Medicare Parts A and B. When you purchase a Medicare Supplement, you’re purchasing peace of mind.

You must be enrolled in Medicare Parts A and B to get a Medigap policy. You will need to continue paying your Part A and B premiums to avoid a lapse in coverage.

There are no provider networks. You can see any health care provider that accepts Medicare assignment. You will not need a referral and if you want a second opinion, then you get it.

It doesn’t cover prescription drugs, but you can get prescription drug coverage by enrolling in Medicare Part D.

There are 10 standard plans, labeled A through N, and each one offers different benefits. If you enroll in one of the most comprehensive plans, like Medicare Plan F plans, your policy will cover virtually all medical costs not covered by Medicare, including the annual deductibles for Plan A and B.

Premiums vary by plan and by individual insurer. That means insurers may charge different amounts for the exact same coverage.

If you enroll during the Open Enrollment Period around your 65th birthday around your Medicare Part B effective date, you cannot be turned down or charged a higher premium because of your age or health. If you enroll later or switch coverage, it may cost more, or you could be denied.

For vision, hearing and dental insurance, you can purchase a separate policy from a private insurer.

Is Original Medicare better than a Medicare Advantage plan?

Medicare Advantage plans offer a Maximum Out of Pocket (MOOP) amount. The MOOP prevents you from spending tens of thousands on covered healthcare services.

For example, if the plan has a $4,000 MOOP; then the most you could possibly pay for the entire year on covered services would be $4,000.

This does not include your premium costs. Original Medicare doesn’t offer a MOOP, you could spend thousands of dollars on healthcare if you only have Medicare.

Which is better Medicare Advantage or Medigap?

Medicare Supplement plans offer the most comprehensive coverage. These plans are standardized by the government and they are designed to go with Traditional Medicare.

When you select a Medigap policy you never need to worry about the insurance company denying a claim; if Medicare approves the service, the insurance company will cover the service.

Medicare Supplements offer you the same coverage each year, with no changes or surprises. The only thing that may change is a slight premium increase. However, if you work with one of our agents, they’ll help you find the company with the fewest rate increases so you save the most.

Medicare Advantage plans have limitations as well as strict networks; if you’re considering an advantage plan, understand that your coverage won’t be the same next year.

This depends on your healthcare needs, budget and lifestyle. The plan that best suits your neighbor, might not be the plan that is best for you.

There are Medicare Supplement plans that cover all the gaps in Medicare, such as Medicare Supplement Plan F.

Figuring Out Your Options

Sorting through your Medicare options can be difficult and time-consuming. At MedicareFAQ, we research top ranked insurance companies to find a plan that works for you.

If you’re searching rates for Medicare Supplements, reach out our agents, they can help you! Our service is 100% free and there’s no obligation to sign up.

Give us a call on our toll-free number listed above. You can call an agent licensed in your state, or use our online feature and complete the rate form here to have an agent start comparing rates for you.