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Compare Medicare Supplement to Medicare Advantage

They Have Similar Names but Very Different Coverage.

by Katie Banks+ on Nov 18, 2014 | 1 Comment

You are not alone if you get Medicare Supplement Insurance and Medicare Advantage Insurance confused. Here we will explain how each work and compare them side by side.

Medicare Supplement Insurance

Medicare Supplemental Insurance (Medigap) plans are federally regulated plans designed to pay for the 1000’s of dollars of “gaps” not covered in Medicare Part A (Hospital Coverage) and Medicare Part B (Doctor Coverage). This means they are by definition more comprehensive than Original Medicare because it supplements Medicare. If you choose Medigap Plan F you generally will have no out of pocket costs during your benefit year.

Medicare Advantage

Medicare Advantage is coverage you sign up for INSTEAD of Medicare, but you’re still in the Medicare Program, and Original Medicare still pays for Hospice care. How it works is Medicare Advantage has a local limited network like a PPO or HMO, reduces your max out of pocket spending to $6700 (Medicare doesn’t have a limit on out of pocket costs), and adds extras like vision, dental, and Rx. These plans also can have $0 monthly premiums. There are great benefits to MA plans, however sometimes patients may find that Medicare Advantage doesn’t cover something they expected to be covered.

HOW DO THEY COMPARE ON…

Plan Benefits:
The benefits of Medigap plans are standardized by the federal government, meaning that Medigap plans sold by different insurance companies all offer the same benefits. Medicare Advantage plans, in contrast, must provide at least the same coverage as Medicare Parts A and B, but vary widely beyond this minimum set of benefits. While researching Medigap is easy, Medicare Advantage plans are so varied that it can take a lot of work.

Doctor Networks:
Medigap plans have the largest network of doctors and facilities across the country while Medicare Advantage plans usually have a small regional network. The size of the network varies by each Medicare Advantage plan provider. Those that travel extensively typically choose Medigap over Medicare Advantage for this reason.

Price:
Medigap plans always require an additional monthly premium while some Medicare Advantage plans with less comprehensive benefits may have no monthly cost at all.  Many of the Medicare Advantage plans, however, require significant cost sharing by its members should medical services be required. Due to recent health care reforms, Medicare Advantage federal reimbursement have changed and many experts believe that future prices of Medicare Advantage plans will increase.

CONCLUSION

Choosing between a Medicare Advantage plan and a Medigap plan is a personal decision. You will want to weigh your budget, network, and needs. If you can afford a little more per month a Medigap plan might be the right choice for you. If you don’t travel a lot, don’t mind a limited network, and are on a tight budget a Medicare Advantage plan might be right for you. Call the number above if you want a Medicare Advantage quote or click here to get a Medigap quote.

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Reader Comments and Questions

Click Here if you have a question

By Bobby l on May 13, 2015

I'm turning 65 in June, and I have a diabetes,and had a heart attack a few years ago. 1) Do I have to answer medical questions for Medigap or Med Adv? 2) Which plan do you think I'll spend less money per year?

Bobby,
Thank you for your questions. Here are the answers to your questions:
1) No, you do not need to answer medical questions for Medigap during your initial 6 month period, and Medicare Advantage do not require you to answer medical questions (unless you have ESRD).
2) This is more subjective. It depends on your specific health needs. We suggest calling us to discuss your situation further at 800-930-7956.
-Amy from https://www.senior65.com/



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PLEASE NOTE: We cannot comment on specific Medicare claims. Contact Medicare directly if you are trying to see if your issue is covered.




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