Difference Between Medicare Advantage Plans and Medicare Supplement Plans
Given how often we hear this question from clients, we thought it was time to clarify this topic.
First, the most important distinction is to point out that they really can’t be compared as plans, but rather as different paths.
Here’s why. Medicare A and B, or Original Medicare is the coverage you sign up for through Social Security when you turn 65 (for the majority of cases). Everyone signs up for that, and the coverage is fairly standardized: generalized, Part A provides hospital care while Part B covers 80% of a variety of medically necessary services, such as surgeries, doctor visits, screenings, and equipment. (For a complete list, visit here for Part A, and here for Part B).
So the next step is to complete coverage—for the remaining 20% that you must pay for Part B services (there is no out-of-pocket maximum, by the way) and to cover prescription drugs. That’s where the choice between Medicare Advantage plans and Medicare Supplement plans come in.
When considering a Medicare Advantage plan, or a Part C plan, think of the Medicare Advantage (MA) plan company a bit like the trustee of your insurance. You sign up with a government-approved independent company, and they now assume the responsibility of covering you as Original Medicare does. Additionally, you receive coverage for many of the holes in Parts A and B—like an out-of-pocket maximum—at an additional monthly premium. The most common MA plans are Health Maintenance Organization (HMO, as you know them) plans and Preferred Provider Organization (PPO) plans.
If going the way of the Advantage plans is the “trustee” route, think of the Medicare Supplement plans, or Medigap plans, as your insurance “partner” plan route. You keep Original Medicare Parts A and B just as they are under the government’s jurisdiction, but you add on two additional partners—the Medicare Supplement plan to cover the 20% left from Part B and a Part D Prescription Drug plan to cover your prescriptions.
How does the coverage differ?
At a glance, most MA plans are going to have significantly cheaper monthly premiums, and for healthier individuals, that can be an attractive draw. In addition, those plans may include dental, hearing, and vision that would not be available through a Medicare Supplement plan or Original Medicare. But, with that low monthly premium comes higher copays and deductibles than with Medigap plans and often a lot of caveats and restrictions. For example, your policy may leave you with a very narrow list of in-network providers that may not include your doctor or hospital of choice. Another consideration is that MA plans provide prescription drug coverage at their discretion. If you have particular prescription needs that are less common, your policy may not cover it. And, if your MA doesn’t cover your Rx, you cannot purchase an additional Part D plan, as per the regulations. Remember, the Medicare Advantage plan is a closed trust; if some part of coverage is not already included, it can’t be tacked on.
With Medicare Supplement plans route, you have more flexibility to tailor your coverage, but it does usually come with a higher monthly premium than the MA plans. Both paths require a yearly evaluation, but Medigap plans require you to reevaluate two different plans a year (both your Medigap plan and a Part D plan) rather than just one. Since your primary insurance remains under Original Medicare, you don’t have to worry about networks—you can go to any Medicare-participating providers. Just as with the MA plan, your Medigap plan provides out-of-pocket maximum protection when your Medicare-covered expenses run high (like unexpected surgeries or long hospital stays). Medigap plans will not offer dental, vision, and hearing, and your Part D plan needs to be chosen carefully to ensure that all your prescriptions are in fact covered.
Medicare Supplement or Medicare Advantage, which one is right for me?
As with all things insurance-related, that answer depends on your individual health needs. For very healthy individuals who have very few prescriptions and doctor visits, MA plans may be better because of the lower monthly premiums. Those savings are immediate, and they continue as long as the insured stays healthy and out of the doctor’s office and hospital. Since MA plans have higher copays, frequent appointments and procedures can quickly eat away at what would otherwise your monthly savings. But when only 9% of seniors self-report their health as excellent, Medicare Supplement plans may be the more viable option. Medigap plans usually end up saving you more money on annual basis because of the lower copays.
Both routes require careful consideration, and before you sit down with a licensed insurance agent, it’s important to consider your finances and your healthcare needs. Conduct some research, start perusing plans on your own with Medicare’s Plan Finder tool, and when you meet with an agent, ask every question that is important to you.
Also, directly ask if he or she is an independent agent or if s/he receives benefits from promoting certain plans and paths over others. Don’t settle for an agent who isn’t, because your personal insurance needs should be first and foremost, and not sullied by the enticement of special promotional commissions.
If you have any questions about your Medicare choices, Griffin Insurance Solutions is an independent agency, and we will happily address them and help you find the best plan for you. Contact us today for in-person appointment by email or phone at 919-704-6147 or 800-774-1434.