What Is The Difference Between Medicare Advantage And Medicare Supplement?

What is the difference  between Medicare Advantage and Medicare Supplement?

Learn how Medicare Advantage combines Parts A and B with additional benefits, while Medicare Supplement fills gaps in Original Medicare.

Explore enrollment, coverage, costs, and the key differences to make informed decisions for your healthcare needs.

What Is The Difference Between Medicare Advantage And Medicare Supplement?
What Is The Difference Between Medicare Advantage And Medicare Supplement? Photo(Free Pik)

 

Medicare Advantage (Part C) and Medicare Supplement plans assist in covering expenses that Original Medicare (Parts A and B) may not include.

While both offer valuable coverage, they serve distinct purposes, and individuals cannot enroll in both simultaneously.

What Is The Difference Between Medicare Advantage And Medicare Supplement?

An infographic on Medicare Advantage vs. Medicare Supplement.
An infographic on Medicare Advantage vs. Medicare Supplement.

Medicare Advantage consolidates Original Medicare Parts A and B, often incorporating Medicare Part D prescription drug coverage.

Some plans may additionally provide benefits like dental, vision, and hearing services.

On the other hand, a Medicare Supplement plan, also known as Medigap, stands alone and is purchased separately.

It serves as additional coverage to assist in covering out-of-pocket expenses that Original Medicare doesn’t address.

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The Medicare Advantage

  • Coverage: Encompasses Original Medicare Parts A and B, with additional benefits such as routine dental, vision, hearing, and fitness services.
  • Enrollment: Specific enrollment periods during the year; allows enrollment or switching to a different Medicare Advantage plan.
  • Doctors and Hospitals: May require the use of in-network doctors and hospitals.
  • Referrals: Referrals may be needed for specialists.
  • Costs: Lower premiums but accompanied by copays.
  • Prescription Drug Coverage: Can be included in a Medicare Advantage Prescription Drug plan (MAPD).
  • Medical Underwriting: Accepts all health conditions, including End-Stage Renal Disease (ESRD).

Medicare Supplement:

  • Coverage: Aids in filling the gaps in Original Medicare, covering out-of-pocket costs not addressed by Parts A and B.
  • Enrollment: Application can be submitted any time after turning 65 and joining Part B.
  • Doctors and Hospitals: Allows visits to any doctor nationwide accepting Medicare.
  • Referrals: No referrals necessary.
  • Costs: Higher premiums but minimal to no copays.
  • Prescription Drug Coverage: Not included; requires the purchase of a Part D plan.
  • Medical Underwriting: No medical underwriting if applied for during the Initial Enrollment Period (starts 3 months before turning 65 and ends 3 months after)

The Medicare Supplement Insurance Explained

Medicare Supplement plans, commonly referred to as “Medigap,” provide coverage for medical expenses not covered by Original Medicare, including copayments, coinsurance, and deductibles.

Some Medigap plans may additionally cover home healthcare, durable medical equipment (DME), hospital costs, and lab costs.

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Eligibility for Medicare Supplement Insurance

You are eligible to purchase a Medicare Supplement plan if you are:

  • 65 years old or older
  • Enrolled in Medicare Parts A and B
  • Residing in the state where the policy is offered
  • Note: In certain states, eligibility extends to individuals under 65 with a disability or end-stage renal disease (ESRD).

Cost of Medicare Supplement Insurance

The cost of Medicare Supplement insurance depends on factors such as your chosen plan, age, and location.

Generally, higher coverage entails higher costs, and some plans may set a maximum out-of-pocket limit.

Understanding Medicare Advantage

Medicare Advantage serves as an alternative to Original Medicare, offered by private insurance companies to Medicare beneficiaries.

These plans include coverage for both Part A and Part B, and some also incorporate Part D prescription drug coverage.

Additional benefits, such as routine vision, hearing, and dental care, may be offered by certain Medicare Advantage plans.

Eligibility for Medicare Advantage

To enroll in a Medicare Advantage Plan, you must:

  • Be enrolled in Medicare Parts A and B
  • Reside in the plan’s service area
  • Be a U.S. citizen or lawfully present in the U.S.
  • Note: Eligibility may extend to individuals under 65 with Medicare due to a disability.

Cost of Medicare Advantage

The costs associated with Medicare Advantage, including premiums, deductibles, and other expenses, vary by plan and can change annually.

Part B premium payments are mandatory to maintain plan enrollment.

Individual plans may feature different out-of-pocket limits, with the plan covering 100% of covered health services after reaching the limit for the remainder of the year.

Changing Medicare Plans

Switching from a Medicare Supplement Plan to a Medicare Advantage Plan:

Medicare Supplement plans assist in covering costs not included in Original Medicare, but they lack benefits like routine dental, vision, hearing, or prescription drug coverage.

If you seek these additional benefits, explore transitioning to an all-in-one Medicare Advantage prescription drug plan.

However, switching from Medigap to Medicare Advantage isn’t a spontaneous process.

You must wait for the Medicare Open Enrollment Period, which occurs annually from Oct. 15 to Dec. 7.

Inform your Medigap insurance company about your decision to cancel before enrolling in a Medicare Advantage plan.

Switching from a Medicare Advantage Plan to a Medicare Supplement Plan:

To return to Original Medicare and purchase a Medigap policy, contact your Medicare Advantage Plan to inquire about disenrollment options.

If eligible to disenroll and revert to Original Medicare, you can only leave a Medicare Advantage plan during two enrollment periods:

  1. The Medicare Advantage Open Enrollment Period (MA OEP) from Jan. 1 to March 31.
  2. The Annual Enrollment Period (AEP) from Oct. 15 to Dec. 7.

Once enrolled in Original Medicare, you are generally eligible to apply for a Medigap plan.

Note:

In most cases, switching from Medicare Advantage to Original Medicare forfeits your “guaranteed-issue” rights for Medigap.

These rights typically extend for six months when you’re 65 or older and enrolled in Medicare Part B.

Without guaranteed-issue rights, insurance companies may require medical underwriting before selling you a plan.

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