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What are the benefits of having a Medicare Advantage Plan vs a Medicare supplemental plan?

By: Ashley Zaikowski

Are you sixty-five and older and/or eligible for Medicare benefits? Our health is invaluable and taking care of it is necessary but, can be costly especially as we get older. Although researching can be time consuming and overwhelming, finding a plan that is the most suitable for you will save you a lot of headache and money in the long run.  While Medicare Advantage and Medicare Supplemental (Medigap) are both options for people with Medicare, there are significant differences between the two plan types so it important to do your research.  Below is some helpful information that might answer some questions you may have.

By the end of 2016, according to a report from the Centers for Medicare and Medicaid Services (CMS), around 33% (or nearly 19 million) of Medicare beneficiaries were enrolled in Medicare Advantage plans or other Medicare health plans, and their popularity continues to grow (Mott, 2018).

Medigap, more formally known as Medicare Supplemental insurance, provides coverage for those that are enrolled in traditional Medicare. Medigap is insurance you can purchase to cover some of your out-of-pocket expenses that traditional Medicare may not cover. Out-of-pocket expenses can add up quickly and may include Part B costs (such as the 20 percent for outpatient services), Part A hospital deductibles, and most medical emergencies while abroad. There are ten types of Medigap policies, all of which are standardized by law. This means that benefits provided by each type of Medigap policy will be the same regardless of seller.

Currently, the most common Medigap policy is Medigap Plan F because they cover the Medicare Part B deductible and excess charges: some Medigap Supplemental plans do not pick up both.  However, starting January 1, 2020 Plan F and Plan C will no longer be offered to new Medicare enrollees. This was determined by Congress according to an article at moneytips.com:

Congress believes that seniors should put more of their own money into their healthcare. With Plan F, seniors wouldn't need to pay anything other than the premium on covered services, so it seems like they could easily be tempted to overuse their healthcare benefits (Engle, 2019).

There are some Medigap plans that cover medical expenses when traveling outside the U.S., while traditional Medicare does not offer this option.  Some of the disadvantages of a supplemental plan is they do not offer coverage for those who have a pre-existing condition.  Also, if you are looking to have your spouse covered under your policy, Medigap only covers one person, therefore a separate policy must be purchased.  There are several different variables to consider and research when deciding a Medigap plan is a good fit for you and your needs.

Medicare Advantage Plans, also known as Medicare Part C, are offered through private insurers who are Medicare approved. There are several types of Medicare Advantage Plans such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-For-Service (PFFS), Special Needs Plan (SNP), HMO point of service (HMOPOS) and Medical Savings Account (MSA). In order to qualify for an Advantage plan, a person must be enrolled with Medicare Part A and Part B benefits.

While every Medicare Advantage plan must cover the same benefits as traditional Medicare there are some differences. Traditional Medicare is mandated by the Federal Government and as such all premiums are the same. Whereas Medicare Advantage plans can charge different copayments and offer extra benefits. Some of these additional benefits may include; low cost premiums, prescription drug coverage and vision services.   Medicare Advantage plans may also offer additional coverage abroad, where traditional Medicaid only offers coverage in US.  All plans, by law, have annual limits on out-of-pocket costs. Another difference between traditional Medicare is that many Advantage plans require you to visit in-network providers, which can be more difficult because there are less options to choose from especially if you travel.  Advantage plans can also be less costly because they typically are paid through premiums, where traditional Medicare you are responsible for the 20% coinsurance and there is no limitation on the out of pocket expenses. 

If you have Medicare because of disability, there are a few additional considerations:

  • Medigap policies are not always available to beneficiaries under age 65
  • Medicare Advantage plans are all available to beneficiaries under age 65, regardless of past and present health conditions, with one exception:
    • You cannot enroll in any of these plans if you already have end-stage renal disease

It is important to consider all the details when deciding whether to enroll in a Medicare Advantage plan or buy a Medigap policy where they both have their advantages. Choosing the best coverage is based on your individual needs.  A good tip to help you decide on coverage, is to look at the star ratings on the Advantage Plan because they are rated by Medicare and they earn their stars based on specific measurements.

Medicare Advantage Plans are rated on how well they perform in five different categories (Medicare Rights Center, 2019):

  • Staying healthy: screenings, tests, and vaccines
  • Managing chronic (long-term) conditions
  • Plan responsiveness and care
  • Member complaints, problems getting services, and choosing to leave the plan
  • Health plan customer service

You can find the ratings and compare plans using Medicare’s Plan Finder Tool, https://www.medicare.gov/find-a-plan/questions/home.aspx, or by calling 1-800-MEDICARE.
 

References
Engle, L. (2019, January 28). Medigap Plans Changing In 2020. Retrieved from moneytips.com: https://www.moneytips.com/medigap-plans-changing-in-2020/267

Medicare Rights Center. (2019, 02 25). How to compare plans using the Medicare Star Rating System. Retrieved from www.medicareinteractive.org: https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/changing-medicare-coverage/how-to-compare-plans-using-the-medicare-star-rating-system

Mott, S. (2018, 09 15). Do I Need a Medicare Advantage Plan? Retrieved from medicare.com: https://medicare.com/medicare-advantage/do-i-need-a-medicare-advantage-plan/