Medicare Advantage vs. Medicare Supplement plans

(This was originally featured in our newsletter on 7/1/2016)

They provide a single plan that combines help with hospital costs, doctor’s visits and other medical services, plus prescription drug coverage if you want it.

The plans are run by private insurance companies, and they all combine coverage for hospital stays with coverage for doctor visits.  You can choose a plan that includes drug coverage, often at no additional premium, or you can choose a plan without prescription drug coverage.

The different types of Advantage plans are HMO, POS, PPO, Special Needs, Private Fee for Service and Medical Savings Plans. You will need to do some homework to figure out which of the plans will best fit your needs.

Look at the monthly premium (if any) you’ll pay to join.  Then estimate your total cost sharing for services.  Find a plan where the maximum out-of-pocket spending fits your budget.  Consider whether a plan’s network (if it has one) gives you access to the doctors you want to see.

If you choose an HMO, POS, PPO and Special Needs Plans, your care is “coordinated”.  That means the plan may coordinate your coverage through a primary care physician who manages the care you receive from specialists and hospitals.  You may have to choose specific doctors and hospitals.  Start shopping by finding what’s available in your area.

     Medicare Supplemental coverage Is private insurance coverage that helps fill the gaps in Medicare Parts A and B.   These plans cover some or all of the expenses that Medicare Parts A and B do not cover like coinsurance, copayments, or deductibles.  These policies are sometimes refered to “Medigap” policies because they fill in the gaps.  There are ten standard plans identified by letter A through N.   Each plan varies in which gaps in coverage they fill, and each standard plan must offer the same basic benefits no matter which insurance company sells it.   It’s important to note that these plans are sold by private companies and usually the only difference between Medicare supplemental polices with the same letter sold by different insurance companies is cost.  On a side note, the more gaps filled in the plan,  the higher the premium.   These premiums vary widely from carrier to carrier so it’s a good idea to do some research.  Also, not all plans are available in all states.  

       In regards to coverage limits, all supplement policies provide an additional 365 days of hospital care during your lifetime beyond the Medicare lifetime reserve days.   In addition,  no Medicare supplemental polices will cover more than 100 days in a skilled nursing facility, and you can visit any provider or facility in the United States. 

     You can buy a Medicare supplemental policy at any time after you reach age 65 and join Medicare part B.   You have a guarantee right to buy any Medicare supplement policy available in your area during the six months after you turn 65 and enroll in Medicare Part B.  This period is known as your open enrollment period.   The best time time to buy a Medicare supplement policy is during open enrollment because during this period the insurance company can’t consider your medical history in setting premiums.   While the insurance company can’t make you wait for coverage to start during this open enrollment,  it may be able to make you wait for coverage related to a pre-existing condition.  

-Jackie Greene and Bev Cline