Medicare Advantage Vs Medicare Supplement
Today’s video explains the various differences between Medicare Advantage Plans and Medicare Supplement Plans.
When it comes to Medicare, everyone gets two main options on how to receive their Medicare benefits. We explain it as a fork in the road so to speak. You have two paths to choose from. The first path is to keep original Medicare Parts A and B as your primary coverage. From there, you can add on a Part D drug plan, and then many people add on a Medicare Supplement Plan to pay all of the co-pays and deductibles and coinsurance that Original Medicare A and B doesn’t pay.
The pros of this Medicare Supplement Path include:
- Very complete medical coverage with little to no out-of-pocket costs at the doctor and hospital.
- The freedom to pick your own doctors and hospitals nationwide, no networks.
- Fewer issues with prior authorizations or claims denials.
The Cons of this Medicare Supplement Path:
- Potentially more in monthly premium payments since you’ll be paying for a Part D drug plan and a separate Medicare Supplement Plan on top of your Part B premium.
- Dental and vision coverage is generally not included.
The other path or the other option is Medicare Advantage, or Part C, of Medicare. These are an alternative to Original Medicare. Medicare Advantage Plans are managed care plans that are funded by the government. You have to be enrolled in Medicare to be on a Medicare Advantage Plan and live in the plan’s service area, and these plans replace your traditional Medicare benefits.
Some of the Pros of Medicare Advantage include:
- Usually inexpensive, often times plans start at $0/month, although you must continue to pay your Part B premium.
- Medicare Advantage Plans also usually include Part D drug coverage rolled into the plan.
- Many plans include “extra benefits” like dental or vision benefits that are not covered by Traditional Medicare
The Cons of Medicare Advantage Plans:
- These are network plans, so you may be restricted in the doctors and hospitals you can use, or you may have to pay higher costs if you use non-network providers.
- You pay copays and coinsurance for most all medical services. The out-of-pocket Maximum on these plans that you may be responsible for can be up to $7,550/year (in 2021).
- You may see more need for prior authorizations or claims denials depending on the plan and insurance carrier.
It’s important to know that the Medicare Supplement Plans, the ones with Original Medicare, are usually medically underwritten plans. This means you generally have to be healthy enough the qualify for the plan. If you’re sick, they can decline you altogether. However, you do get one chance to get a Medicare Supplement Plan without medical underwriting and that’s when you first turn 65 or first add Part B. After this time, you’ll generally have to be healthy enough to qualify if you want one of the plans down the road. For Medicare Advantage, there is an annual enrollment period each year when you can get one of those plans, no health questions, and no medicare underwriting.
Let us know what questions you have! Deciding between a Medicare Supplement Plan and a Medicare Advantage Plan can be tricky, and you’ll want to fully assess your needs, and your budget first. Our licensed agents are here to help (888) 465-9728.
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