Trying to figure out everything you need to know to compare Medicare Supplements vs Medicare Advantage plans? Medicare Supplements and Medicare Advantage plans can be very confusing and most of the time we head to the internet for answers.
Well, guess what:
For an advisor Medicare Supplements vs Medicare Advantage plans are fairly easy to understand, but for someone doing it on their own there are usually many questions that might not get answered when you are searching the internet for coverage.
In this post we will answer some of the most asked questions on the internet and prepare you for how you can compare plans for your Medicare needs.
1. Who Regulates Medicare Supplement Plans?
In 1990 the federal government placed the Omnibus Budget Reconciliation Act (OBRA) into law which standardized all Medicare Supplement Policies.
Overall, Medicare Supplement plans are state regulated, but the above law made these policies subject to minimum federal requirements.
This law did things like standardizing plans so there isn’t any confusion about your benefits as well as requiring that Medicare Supplement plans are guaranteed issue when someone turns 65 years old during the first 6 months of their enrollment to Medicare Part B.
During this 6 month period they also can’t do things like charge you more because of any pre-existing conditions.
Outside of federal law, the states can also enact their own minimum standards like limiting insurance agents commissions to make sure they aren’t switching customers companies every year for a commission.
2. How Many Medicare Supplement Plans Are There?
There are a total of 12 Medicare supplement plans as of 2022, these plans are:
- Plan A
- Plan B
- Plan C
- Plan D
- Plan F
- High Deductible Plan F
- Plan G
- High Deductible Plan G
- Plan K
- Plan L
- Plan M
- Plan N
The best thing about Medicare Supplement plans is that they are standardized, this means that no matter what state you are in (outside of Massachusetts, Minnesota, or Wisconsin) all of the plans will offer the exact same benefit.
This also makes it easier to pick a company since no benefits will change, most companies can offer additional benefits, but can’t offer less benefits.
So, if you aren’t sure which option will be best, you can always go with price first, since every product is the exact same no matter the company.
Thrivent’s Plan A will be the same as Mutual of Omaha’s Plan A.
3. Which Of The Following Must Be Present In All Medicare Supplement Plans?
As I stated above, Medicare supplement plans are standardized in 47 states and on the most basic level, no matter what state you live in, they all have to cover some parts of:
Medicare Part A coinsurance costs up to an additional 365 days after Medicare benefits have been used up.
- Medicare Part A hospice care coinsurance or copayments
- First three pints of blood used in a medical procedure
- Medicare Part B coinsurance or copayments
Depending on the plan that you choose, there are even more benefits.
For example:
Medicare Supplement Plan G, one of the most all-inclusive Medicare Supplement plans, has the following extra coverage benefits:
- Medicare Part A deductible
- Part B excess charges
- Part B preventive care coinsurance
- Skilled Nursing Facility (SNF) care coinsurance
- Foreign travel emergency care
Some plans may include additional benefits like the Silver Sneakers Program.
The only states where the benefits are going to be different are Massachusetts, Minnesota, or Wisconsin.
Medicare Supplement plans in those states are different and you will probably want to speak with an agent to help you figure out exactly how they will work.
On the other side of things, a Medicare Supplement plan does not have to cover vision, dental, hearing aids, or long term care. These items can be covered with a separate dental-vision-hearing plan and a separate long term care plan designed to cover long term stays in a nursing home or provide long periods of home health care benefits. Keep in mind when shopping for plans to go along with Medicare in MD there are quite a number of choices and options to cover your future medical expenses.
4. When Can You Change Medicare Supplement Plans?
There is a part of the year known as the Medicare Open Enrollment Period which confuses many retirees since it is really called the Annual Election period or AEP.
This is the time period you can change your Stand-Alone Part D Prescription Drug Plan (PDP) or your Medicare Advantage Plan (MAPD) and it usually lasts from October 15th to December 7th every year. Understand that this period does NOT pertain to Medicare Supplements.
There is no specific period where you can change Medicare Supplement plans each year. In fact if you get a rate increase and want to shop your current plan, you can do so at any time. Keep in mind that to actually switch to another Medicare Supplement plan, the new insurance company will likely require you to answer health questions. Depending on your current health conditions, you may be declined from the new carrier, so never cancel your existing coverage before you have your new policy in hand.
In certain states there are special provisions that may allow a person to change their Medicare Supplement plan such as the birthday rule. States that have the birthday rule ensures that a consumer can switch to another carrier as long as they are getting the same coverage or less without underwriting. The birthday rule can be handled differently in each state that offers it. Right now the only states providing Medicare beneficiaries with the birthday rule provision are Oregon, California, Idaho, Illinois, and Nevada.
If you thinking about switching from a Medicare Supplement to a Medicare Advantage Plan or you have a Medicare Advantage plan and want to switch to a Medicare Supplement then you will be able to do so during the Annual Enrollment Period.
It is very important to do your research before your Annual Enrollment Period so that you know what could happen to your policy. Plans for Medicare in Maryland have many more options when looking at Medicare Supplements compared to a Medicare Advantage plans. In fact there are only several carriers offering Medicare Advantage plans in Maryland (and only in certain counties) compared to a large amount of carriers offering Medicare Supplement plans statewide.
For Instance:
If you are currently enrolled in a Medicare Advantage Plan and decide to switch to a Medicare Supplement plan, you could be denied coverage due to your current health. Also keep in mind that unlike a Medicare Advantage plan, a Medicare Supplement plan’s premium is based off your current age when you enter the plan.
If you are currently enrolled in a Medicare Supplement Plan but want to switch to a Medicare Advantage Plan, you can do so during the Annual Enrollment Period, but your coverage will not be effective until January 1st of the following year. This means that if you enroll in a Medicare Advantage plan on October 15th, do NOT immediately cancel your Medicare Supplement plan since you will need that coverage for the rest of the current year.
5. How Long Is An Open Enrollment Period For Medicare Supplement Policies?
Each person has their own 6 month time table for applying for a Medicare Supplement plan.
It is your personal Open Enrollment period and it starts on the first day that your Medicare Part B becomes active.
For Instance:
If your Medicare Part A and B starts on Jan 1st then your personal enrollment period will last until July 30th.
This usually happens when you turn 65 years old and start to receive your Medicare Part B benefits. In many states you can also purchase a Medicare Supplement up to 6 months in advance of when you are turning 65. The plan will not go into effect until your Medicare benefits do. This means that if you are in a state that allows advance purchase of 6 months and you are going onto Medicare effective August 1st, then you can purchase your plan in February. The Medicare Supplement plan will not go into effect until August 1st as well.
If you are wanting to purchase a Medicare Advantage plan when turning 65 you can enroll up to 3 months prior, during the month you are turning 65 and up to 3 months after you turn 65. This period for Medicare Advantage is known as the Initial Enrollment Period (IEP).
Keep in mind, if you continue to work after age 65 and have proof of comparable insurance coverage, your Medicare Supplement Open Enrollment period can be pushed back to later when you retire.
Can I purchase Outside Of My Open Enrollment Period?
Outside of your Personal 6 month enrollment period, you can actually purchase a Medicare Supplement plan at any time of the year.
However, you have to keep in mind that if you miss your 6 month window, or decide to look for more affordable coverage, you can be asked health questions.
There is a possibility, that based on your health, you won’t be able to switch products or if you missed your cut-off, you won’t be able to get a Medicare Supplement plan.
The best time to get a Medicare plan is going to be during your initial personal open enrollment for Medicare Supplements because you are guaranteed approval (no health questions), and during your Initial Enrollment Period for Medicare Advantage.
Here is where you have more flexibility with a Medicare Supplement. When comparing Medicare Supplements vs Medicare Advantage plans outside of your initial enrollment period, a Medicare Advantage plan does not have the flexibility to be changed anytime throughout the year.
6. Does Every State Have Medicare Supplement and Medicare Advantage Plans?
Every state has Medicare Supplement plans in some form or another, with the main differences happening in Massachusetts, Minnesota, or Wisconsin.
Each state; however, doesn’t have to offer the same plans. This means that State 1 could offer Plans A, B, N, and G and then State 2 could offer Only Plans N, G, F and B.
While each state can offer whatever Medicare Supplement Plans they choose, they can’t offer less benefits than another state.
Wisconsin Basic Medicare Supplement Benefits
If you live in Wisconsin, your basic Medicare Supplement Benefits are:
- Inpatient hospital care: covers the Part A coinsurance
- Medical costs: covers the Part B coinsurance
- Blood: covers the first 3 pints of blood each year
- Part A hospice coinsurance or copayment
Minnesota Basic Medicare Supplement Benefits
If you live in Minnesota, your basic Medicare Supplement Benefits are:
- Inpatient hospital care: covers the Part A coinsurance
- Medical costs: covers the Part B coinsurance
- Blood: covers the first 3 pints of blood each year
- Part A hospice and respite care cost sharing
- Parts A and B home health services and supplies cost sharing
Massachusetts Basic Medicare Supplement Benefits
If you live in Massachusetts, your basic Medicare Supplement Benefits are:
- Inpatient hospital care: covers the Part A coinsurance
- Medical costs: covers the Part B coinsurance
- Blood: covers the first 3 pints of blood each year
- Part A hospice co-insurance or copayment
- 365 additional days of hospital care after Medicare coverage ends
While Medicare Advantage plans are available in all states, they are not necessarily available in all counties. When looking to compare Medicare Supplements vs Medicare Advantage plans, you will see that not every county has a Medicare Advantage plan available in it. This is a big difference in options that are available to state residents. The Medicare Supplement plans must be provided on a statewide basis since they are overseen by the state, but Medicare Advantage plans may pick and choose which counties they want to offer a plan in. When shopping Advantage plans to be your primary plan, you must reside in the county that the plan is available. If you reside in a county where there are no Medicare Advantage plans available then you will not be able to enroll in one. So in this particular case when we compare Medicare Supplements to Medicare Advantage plans….the Medicare Supplement is the clear choice.
7. Which Medicare Supplement and Medicare Advantage Plans Offer Silver Sneakers?
This is a great question and could be the determining factor in which company you finally decide to purchase coverage through.
If you don’t know what Silver Sneakers is, let me catch you up to speed.
The Silver Sneaker program encourages older adults to participate in physical activities that will help them to maintain better control of their overall health.
It is available around the country, and membership provides access to any gym that participates, including all amenities included with basic level access.
Think of it as a program that will help you stay fit both mentally and physically.
Some of the carriers that offer Silver Sneakers Are:
- Blue Cross Blue Shield
- Aetna
- Humana
- Kaiser Permanente
- Mutual Of Omaha
- United Health Care
While this can be a nice extra benefit, you must still weigh the value up against the cost of that carriers plan. If a Medicare Supplement carrier offering the Silver Sneakers benefit has a plan that is $40 or more per month over another carrier offering the same plan, you might be better off going with the lower priced plan (that offers the same health benefits) and buying your own gym membership since many offer discounts to those who are over the age of 65. If you are comparing Medicare Advantage plans that both offer Silver Sneakers it is best to take compare not only the plan’s premiums but also their co-pays and maximum out of pocket costs you are responsible for in a calendar year.
8. What Is The Average Cost Of Medicare Supplement Insurance?
There are many factors that go into the costs of a Medicare Supplement plan, and that is because health insurance companies can price Medicare Supplement plans in three different ways:
Community Rated
Community rated is when premiums are based on everyone currently covered, so it isn’t based on your individual age.
Issue Age Rated
Premiums rated based on issue age will be based on how old you were when you first purchased the policy.
Attained Age Rated
If your premiums are based on an attained age, this means as you get older your premiums will also increase. Most plans filed by insurance carriers in the state of Maryland are attained age rated.
Health insurance companies’ prices can vary by a large percentage, so always remember that there isn’t any difference in the base of the plan.
Below are some average rates (Age 70 year old female, non-tobacco user, resident of Maryland)
| Medicare Supplement Plan | Average Monthly Premium |
|---|---|
| Plan A | $127.05 |
| Plan B | $158.75 |
| Plan C | $217.57 |
| Plan D | $198.10 |
| Plan F | $153.46 |
| Plan G | $128.32 |
| Plan K | $79.41 |
| Plan L | $108.87 |
| Plan M | $179.33 |
| Plan N | $100.24 |
Keep in mind that these rates are an average of Supplement plans and should only be used when comparing plans for Medicare Supplements in Maryland. They can be more or less depending on your specific situation such as the state you are a resident of, whether or not you use tobacco, and what your age is.
9. What Is The Best Medicare Supplement Insurance Plan?
The most purchased plan used to be Medigap Plan F; however, the recent news of Plan F no longer being available to those new to Medicare after 2019, Plan G is quickly gaining popularity.
Medicare Supplement Plan G, also called Medigap Plan G, or Medsup Plan G, is one of the best health insurance products that is offered through private insurance companies.
These Medicare Supplement plans work in parallel with Medicare Part A (which is hospital insurance) and Medicare Part B (which is medical insurance)
The only difference between Plan F and Plan G is that Plan G doesn’t cover the Annual Part B deductible, other than that, the benefits are:
- Medicare Part A hospital coinsurance
- 365 Hospital Reserve Days
- Part A hospice care coinsurance or copayment
- Part A deductible
- Medicare Part B preventive care coinsurance coverage
- Part B coinsurance or copayment coverage
- Part B excess charges
- First three pints of blood for a medical procedure
- Skilled Nursing Facility (SNF) care coinsurance coverage
- Foreign travel emergency coverage, up to the plan limit
Plan G is going to offer the most benefits when it comes to covering the gap of Original Medicare and in our opinion is going to be the best Medicare Supplement Plan.
No matter which company you choose, a Plan G is a Plan G, so if you hear a company name that you might not be familiar with, but it has the lowest monthly rate, don’t rule out that plan. At this time when folks are shopping for a Medigap plan they lean towards purchasing a Medicare Supplement Plan G due to very little additional out of pocket costs.
10. How Do Medicare Advantage Plans Work?
It is important that you understand that Medicare Advantage plans are not a supplement to Medicare. Medicare Advantage is actually Part C of Medicare and replaces your Original Medicare Parts A and B. Many times Medicare Advantage plans are referred to as cost sharing plans. This is because while the premiums are extremely low, you will have out of pocket costs on most services. An example would be a $20 co-pay each time you visit your primary care physician, maybe a $40 co-pay each time you visit a specialist, a hospital co-pay of $300 per day for the first 5 days, 20% co-insurance for lab work, and the list goes on.
Medicare Advantage plans in Maryland are limited to just a few carriers as of today such as Humana, Johns Hopkins, and Kaiser. With this limitation and comparing Medicare Supplements vs Medicare Advantage plans, the winner for Medicare choices is in favor of Medicare Supplements. In other states such as Virginia where there are many more Medicare Advantage plans and larger networks, the choice could be quite even.
11. What Is The Difference Between Medigap And Medicare Supplement?
The word Medigap is actually a play on how the Medicare Supplement Plans work.
These plans are made to cover the GAP’s that Original Medicare will not cover and that is where the name Medigap comes from. These names are used in all states and not just when shopping plans for Medicare in MD.
They have 2 different names, but they are the exact same thing.
So You Have Medsups, Medigap, and Medicare Supplement Plans.
12. What Is The Difference Between Medicare Advantage And Medicare Supplement?
These two words probably are the ones that get mixed up the most and this is one of the most commonly asked questions.
While they are both products offered through private insurance companies they work and do two entirely different things.
Both of these plans cost money in addition to the plan premiums for your original Medicare.
Although, you are able to find some $0.00 premium Medicare Advantage plans in some states, other states have plans with premiums that range from $25 – $125 per month.
You also can’t have both of these plans at the same time and below is a simple chart of the differences of Medicare Supplements vs Medicare Advantage:
Medicare Advantage |
Medicare Supplements |
|
|---|---|---|
|
In Relation to Original Medicare Parts A & B |
Private health plan that provides Part A & B benefits directly in place of Regular Medicare. |
Private gap coverage that pays all or most Part A & B out-of-pocket expenses. |
|
Premium |
$0 to more than $100 a month depending on the plan. Anyone enrolled will pay the same no matter of age or health history. |
Average of about $125 to $225 a month. Can vary by age, health history, or Company. |
|
Out-of-pocket costs |
In-network medical deductibles and co-pays of $3,240 up to $10,000 a year, depending on the plan. |
Very Low Cost to None (excluding the monthly premium) |
|
Choice of doctors and hospitals |
HMO: Plan providers only. PPO: Any provider, but out-of-network providers cost more. |
Any Provider that participates in Medicare. |
|
When Can You Purchase |
When you first enroll in both Medicare A and B and annually thereafter during Open Enrollment (Oct.15 – Dec.7). |
First six months after you sign up for Part B and are at least 65 years old. |
|
Part D Prescription Coverage |
Most plans include Part D coverage. |
Not included. You must buy a separate Part D plan for this. |
|
How Provider Is Paid |
You pay deductibles and Co-pays directly to providers. |
Medigap almost always automatically cuts a check to providers after Medicare pays its share. |
Frequently Asked Questions (FAQs)
When can you change Medicare Supplement Plans? There is no set date during the year when you can change Medicare Supplement plans. There are a few things to keep in mind when deciding to change your Medicare 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 Medicare Supplement plans with pre existing conditions? This is not a simply yes/no answer. Some Medicare 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 a 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 plans have 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 Medicare 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 a Medicare Advantage plan 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.
Taking Action
Now that your main questions about Medicare Supplements vs Medicare Advantage plans have been answered it is time to take the next step.
Feel free to give us a call toll free at 1.800.924.4727 or complete the form request here.
With all insurance products, the longer you wait the more complicated the outcome can get, so there is no need to wait.