Medicare is a health insurance program that provides coverage for older individuals and people with disabilities. The Medicare Advantage and Medicare Supplements (Medigap) were developed to provide options to extend healthcare to help people needing more coverage than the traditional Medicare plans. When choosing Medicare Advantage vs. Medicare Supplements, there can be a lot keep in mind.
Between these two options, there are many things to consider when deciding which is right for you, and you can only choose one. This guide will break down the differences to help you understand how these policies work to make the best decision for you and your healthcare needs.
How Medicare Works
Medicare insurance plans have different coverages depending on your needs. These plans have a deductible you’ll have to meet and coinsurance. It’s a customizable pick-and-choose coverage, but it can be hard to choose a plan that covers everything you need. The plans consist of four parts: Part A, Part B, Part C, and Part D.
Part A: Part A is a Medicare plan that covers inpatient hospital stays, hospice care, nursing home facilities, and some other coverages.
Part B: Part B covers medical services, outpatient care, medical supplies, and preventative care.
Part D: Part D is dedicated to covering prescription drugs, many shots, and vaccines.
Original Medicare plans often will not include vision, dental, hearing, or prescription drugs, so you often have to pay for that care out of pocket. This is where Medicare Advantage or Medicare Supplement Plans come in.
What is Medicare Advantage?
Medicare Advantage (MA), also referred to as Medicare Part C, is an option to receive private health insurance through the Medicare program at a lower cost. This plan is an alternative to original Medicare coverage, and you cannot choose this plan with Part A or Part B.
Because this is a standalone option, these plans provide coverage for dental, vision, hearing, prescription drugs, and other services not usually covered by Medicare. Medicare Advantage Plans are offered through private insurance companies contracted through the government and are required to offer the same coverage as original Medicare.
The costs for Medicare Advantage are low to no-cost premiums, and you’ll often have to pay coinsurance, deductibles, and copays. Still, there are out-of-pocket limits on how much you have to spend every year.
What are Medicare Supplement Plans (Medigap)?
Medicare Supplement insurance plans, also called Medigap, work with your original Medicare coverage. It can cover many options that Part A and Part B do not cover. It can also take on some of the expenses of your coinsurance and deductible to help remove that financial burden when receiving health care services. Choosing Medigap comes with a monthly premium, which varies per supplemental insurance plan. The monthly costs can add up significantly and be as high as several hundred every month.
What are the Pros and Cons of Medicare Advantage and Medical Supplement plans?
There are a few differences between Medicare Advantage and Medical Supplement plans, and it’s important to understand the pros and cons of each.
Medicare Advantage Plans are an all-in-one option with lower monthly premiums. They include dental, vision, preventive care, prescription drug coverage, and more. With MA, there are lower monthly premiums and vast options for plans.
The downside of Medicare Advantage is there are potentially higher maximum out-of-pocket costs annually that could be costly if you need a lot of medical attention. MA plans are more restrictive to specific hospitals and primary care doctors, and many plans require referrals if you need to see a specialist. The coverage only covers you in the plan’s service area and does not travel with you.
Medicare Supplement Plans
Medicare Supplement plans work together with original Medicare plans to provide you with low to no out-of-pocket costs with no network restrictions. You do not need to have referrals to see a specialist, plans are standardized, and you are covered anywhere in the U.S.
With Medicare Supplement plans, you will likely pay a higher monthly premium because you are adding on coverage. There are only 12 Medicare Supplement plans to choose from to add on coverages such as dental, vision, hearing, and prescription drugs, so your choices are limited. Navigating the available Medicare Supplement plans in your area may prove difficult without the help of a licensed Medicare agent.
What is the Difference Between Medicare Advantage and Medicare Supplement Plans?
The difference between the Medicare Advantage and Medicare Supplement insurance plans is that Medical Supplement plans can work as secondary coverage to original Medicare. While Medicare Advantage can be a primary source of insurance coverage. Like traditional medical insurance coverage, there is no one plan that will fit your needs.
Which One is Right for You: Medicare Advantage or Medicare Supplements?
Choosing between Medicare Advantage and Medicare Supplement insurance plans depends on your lifestyle, finances, and health conditions. You want to take into consideration a few factors before you make a decision to enroll in either choice.
- Costs – Medicare Advantage plans can save you money on your monthly premiums, but the costs vary depending on the insurance provider, and you may need to add on Part D to cover your prescription drugs. Be sure to look at all costs of each option regarding copay, premiums, and other out-of-pocket expenses.
- Doctors – Original Medicare allows you to choose any doctor that accepts Medicare, while Medicare Advantage plans are more restrictive. If you have a doctor you prefer to see, you want to check if they are in-network and covered under any potential insurance plan.
- Health Condition – Your health condition should be considered when choosing between Medicare Advantage and original Medicare plus Medicare Supplement plans. Medicare Supplement may be better if you need more care, including seeing specialists, and want more freedom in your doctor choices. Although Medicare Advantage plans have higher out-of-pocket premiums, they may be a better option if you have higher medical bills.
Medicare Advantage is ideal for people looking for a low monthly premium and who do not need to visit the doctor often. Medicare Supplement is ideal for those who want lower out-of-pocket costs, more freedom to choose their doctors, and predictable monthly premiums. Ultimately the choice comes down to your medical needs, preferences, and lifestyle.
Brighter Insurance is an independent agency, which means that we have developed relationships with a wide variety of insurance providers. Our licensed Medicare agents are available right now to offer guidance, answers, and expertise when it comes to choosing your ideal Medicare coverage. Click here to learn about your FREE Medicare consultation now.