Medicare Advantage vs Medicare Supplement…which is the better choice?
The truth is that there are many differences between Medicare Supplement Insurance and Medicare Advantage Plans. Both can be beneficial when you understand what they offer.
Keep in mind that you can only have one or the other.
This article will highlight the main components of both types of plans to help you decide the best course for you when it comes to the medical coverage you need.
Two Types of Plans
Types of Medicare Plans
Health Maintenance Organization Plans (HMO)
Preferred Provider Organization Plans (PPO)
Private Fee-for-Service Plans (PFFS)
Special Needs Plans (SNPs)
HMO Point-of-Service Plans (HMOPOS)
Medical Savings Account Plans (MSA)
Each type has different rules and features regarding networks, referrals, and out-of-pocket costs.
Highlights Of Advantage Plans
You pay healthcare costs through daily co-pays and coinsurance with Medicare Advantage. People who have these plans tend to pay less in monthly premiums, but have more out of pocket exposure. During years when there is not much plan usage, a beneficiary is likely to pay less in total medical expenses. However, those who suffer from chronic health conditions who enroll in this plan can often experience higher out-of-pocket costs due to hospital stays and co-insurance payments.
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Additional Benefits of Medicare Advantage Plans
Some plans may even offer transportation to doctor visits, over-the-counter benefits, and meal benefits. These extra benefits can be particularly attractive to beneficiaries looking for comprehensive coverage beyond just medical and hospital insurance.
However, it’s crucial to understand that medicare plans can change their benefits, provider networks, and drug formularies annually.
This means you’ll need to review your plan each year during the Annual Enrollment Period (October 15 – December 7) to ensure it still meets your needs.
Highlights Of Supplement Insurance
Original Medicare and Medicare Supplement Insurance plans do not have provider networks. This means the they can see any doctor or specialist that accepts Medicare with no referrals required. Congress made one change to Medicare Supplement Insurance worth noting. If you become eligible for Medicare after January 1, 2020 you cannot purchase a plan that provides coverage for the Part B deductible. This means that you cannot purchase a Plan C or Plan F.
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Standardization and Coverage of Supplement Plans
Another advantage of Medicare Supplement plans is that they offer nationwide coverage. This can be particularly beneficial for people who travel frequently within the United States or split their time between different states.
Factors to Consider When Choosing Between Medicare Advantage and Medicare Supplement
Costs: Compare monthly premiums, deductibles, copayments, and out-of-pocket maximums.
Coverage: Assess your healthcare needs and which plan best covers them.
Provider networks: If you have preferred doctors or hospitals, check if they’re in-network for Advantage plans you’re considering.
Prescription drug coverage: Determine if you need this included in your plan.
Additional benefits: Consider if you need or want extras like dental, vision, or hearing
coverage.
Travel: If you travel frequently, a supplement plan might offer more flexibility.
Health status: If you have chronic conditions or expect high healthcare utilization, a supplement plan might provide more comprehensive coverage.
So Which Plan Is The Best?
Frequently Asked Questions (FAQs)
There is no set date during the year when you can change supplement plans. There are a few things to keep in mind when deciding to change your supplement plan before it comes up for renewal.
If you pay your premium annually, you will need to wait until the new policy is issued and then you can apply for a refund of unused premiums from your current company. You should never cancel your existing coverage before your new policy has been approved.
Can you change supplement plans with pre-existing conditions?
This is not a simple yes/no answer. Some supplement insurance companies may look at a pre-existing condition as too severe and will not issue a policy, where another carrier may not view the pre-existing condition as un-insurable. Of course, there are certain conditions that insurance companies are going to shy away from such as currently being treated for cancer, on kidney dialysis, or have an upcoming surgery planned. The best thing you can do is simply talk with an insurance advisor and let them see what all your options are.
What is the best Advantage plan for Medicare?
The best Medicare Advantage plan is the one that covers your individual needs with the least amount of financial exposure. While Medicare Advantage has what are known as Star Ratings, this is only one way to measure which plan you should investigate further. You need to look at the network of providers to see if all your doctors and facilities participate.
In addition, you need to make sure that all your prescriptions are being covered on the plan’s formulary list. Also, don’t get caught up in the low co-pays when seeing your primary care physician. While a $20 co-pay doesn’t seem like much, you need to be aware of the fact that this adds up when seeing your doctor multiple times a year.
Throw in some visits to a specialist who has a $40 co-pay and the amounts start to add up. Speaking of co-pays, don’t forget that most Advantage plans have a daily hospital co-pay that can be upwards of $300 per day up to 5 days in the hospital.
The good news is that Medicare Advantage must offer a cap on what you can be out of pocket for in a calendar year. All the approved expenses that you pay out of pocket go towards this cap. It is important to be aware of what the plan’s maximum out of pocket amounts are each year. Some can be as high as $10,000 for a calendar year.
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Taking Action
With all insurance products, the longer you wait, the more complicated the outcome can get, so there is no need to delay in making your decision.