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Medicare Supplement vs. Medicare Advantage Plans

Comparing Medicare Supplement Plans vs. Medicare Advantage Plans can be helpful for people who are considering either option. From our experience, we feel that Medicare Advantage Plans are no where close to what the insurance companies boast, and many people who are enrolled in Medicare Advantage Plans are often very disappointed with the coverage a few short years after they are enrolled. Although Medicare Advantage Plans are beneficial for some people, most of our clients prefer Medicare Supplement Plans due to their comprehensive coverage, ease-of-use, and little to no out-of-pocket expenses.

A Side-by-Side Comparison of Medicare Supplements vs. Medicare Advantage Plans
Questions? Medicare Advantage Medicare Supplements
How are the plans funded? Medicare pays the Medicare Advantage Plan a fixed amount based on the area’s usual and customary charges for medical services per enrollee to manage each member’s care. Members also may be required to pay a Medicare Advantage Plan premium. Policyholder premiums.
Do I continue to pay my Medicare Part B premium? Yes. Yes.
How can there be little or no premium for Medicare Advantage plans? There may be a small premium initially, however there are costs and they can go up annually.
Medicare’s reimbursements to the Medicare Advantage Plans may not keep pace with medical inflation. This can lead to the plan raising premiums, increasing co-payments, decreasing benefits and dis-enrolling members every year.
No surprises. The benefit structure is locked in. You know what you’re getting year to year. As Medicare deductibles and co-payments increase, so do your Med Supp benefits.
Benefits don’t decrease if plan premiums increase.
What does it cost me?
  • Medicare Part B monthly premium
  • Monthly Medicare Advantage premium (possibly)
  • Monthly Medicare Advantage premium for the extra benefits chosen
  • Deductibles and co-payments
  • Medicare Part B monthly premium
  • Monthly premium
What does the plan cover? At least what Medicare would cover plus some additional benefits not covered by Medicare. However, many services require you to cost share increasing your out-of-pocket costs. Medicare pays its portion of eligible expenses. Your Medicare Supplement pays the eligible expenses not paid for by Medicare. Plan F pays 100% of eligible expenses not paid by Medicare.
Can I budget for my monthly health care expenses? It’s tough. You typically must pay when you go to the hospital or doctor, plus you may have a monthly plan premium. Yes. You have a monthly premium and little or no out-of-pocket expenses whenever you need care.
Can my plan be canceled? Yes. Contracts between the government and the Medicare Advantage Plan are reviewed annually. The plan may not be renewed and can terminate its members. No. Only you can cancel your plan by not paying the premium.
May I choose my hospital and care providers? Typically, you choose from a network of providers, which can fluctuate. Yes.
Is pre-certification or qualification required? Yes. The Plan usually requires pre-certification or qualification for some types of care. Penalties may apply if you don’t follow the rules. No.
Can I use hospitals and doctors everywhere? Probably not. Check the plan for details and termination provisions if you move out of the service area. Most often you are required to see only doctors and hospitals that are within your network area. Yes. You may choose any doctor or hospital within the U.S. that accepts Medicare.

 

When you compare Medigap and Medicare Advantage plans, it is also important to keep in mind the current healthcare legislation. Funding cuts of $132 billion to the Medicare Advantage system are going to greatly impact the quality of coverage and cost of Medicare Advantage Plans. It is important to thoroughly understand the benefits of the insurance policy you purchase. By consulting one of our Medicare Specialists', you can be confident that you understand the differences between Medigap and Medicare Advantage Plans.

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