After you have enrolled in Medicare, there are a number of decisions that you must make regarding your health care coverage. While it may seem like these decisions are about your Original coverage, they do not simply stop at having Part A and B medical coverage. You can also decide whether you need additional coverage that can only be provided by a Part C plan.
Yes, that's right. It is time to decide whether an Advantage Plan is right for your medical needs, or whether you want to stick with Original coverage. If you stay with Original coverage, you will be able to pick up a Supplement plan that will provide you with extra benefits. This may seem like a lot to take in, but let's see what each of these options have that can benefit you.
Keep in mind that this article is for information purposes only. You should not make your final decision based on any recommendation you find here. You should carefully evaluate your available Medicare Advantage vs. Medicare Supplement options based on your own health care and prescription needs.
What’s The Difference - Advantage Vs. Medigap
While you may be confused initially, we will bring the benefits and risks of Medicare Advantage vs. Medicare Supplement to light right away. If you have significant health problems, and your healthcare expenses are high because of them, you will probably be better off staying with Original Medicare and choosing a Medigap supplement.
Each geographical location has varying availability options for Medicare Advantage vs. Supplement Plans. Because of this, we cannot make any direct recommendation, even if you have ideal health.
If your health is considered good, and you do not typically expect a lot of medical bills to come your way, Medicare advantage costs would be lower in your situation. Essentially, if your health care costs a lot each year, you will want to sign up for Medigap.
On the other hand, if you are on expensive prescriptions, an Advantage plan would save you a lot of money on your prescription expenses. This would save you a significant amount of money compared to Part D, which can leave you with a large out-of-pocket expense.
Even if it sounds like a good idea to have both, which would be a great addition to the Medicare system, you cannot have both plan options. Unfortunately, you must choose one option or the other.
A Look At Medicare Advantage
Medicare Advantage, more commonly called Medicare Part C, allows you to obtain customized insurance plans from an individual, private insurance companies that have been approved by the Centers for Medicare and Medicaid Services, or CMS.
These companies are required to provide all of the services that are given by Parts A and B, but they are not required to cover hospice care. If you are on a Part A or B and require hospice care, Part A will cover the approved costs.
An Advantage plan will be able to provide services that are not covered under Parts A and B, including:
- Vision
- Dental
- Prescription Drug Coverage
- Coverage for end-stage renal disease (usually these patients are required to stay on Parts A and B.)
Patients who have end-stage renal disease who do qualify for an Advantage plan will need to continue paying their Part B premium because this is the portion of their coverage that will cover most of their treatment.
A Look At Medicare Supplement
This form of supplement plan is also offered by individual private insurance companies. It picks up some of the medical costs that are not covered by Parts A and B. The primary coverage it offers includes picking up the following:
- Deductibles
- Premiums
- Copayments
When you are comparing Medicare Advantage vs. Medicare Supplement plans, the first thing you will notice is that supplement plans are placed in categories according to the benefits. These categories are identified by letters of the alphabet.
You will also notice when comparing Medicare Advantage vs. supplement plans that the prices of each plan vary depending on the coverage.
Supplement plans do not provide members with prescription drug coverage either. You will need to enroll into a stand-alone Part D coverage to obtain supplemental benefits on your prescription copayments.
Are Advantage Or Supplemental Plans Better?
When you are deciding on a Medicare Advantage vs. Medicare Supplement plan, you will need to compare the out of pocket expenses associated with each. If you choose an Advantage plan, you will still be required to pay your Part B premium, as well as the Premium for your Advantage plan. If you choose a supplement plan, your benefits will fall into a standard pricing category.
Keep in mind, the cost of Medicare Advantage vs. Medicare Supplement plans may be different in your area, so evaluate each option carefully and make sure the prices you see advertised apply to where you live.
When you are comparing the positives and negatives of your options, focus on these key factors:
- Cost of premiums
- Cost of Deductibles
- The expected health care services you will need
- The expected services you will need from the hospital, and how often your medical conditions warrant a visit
- Restrictions on doctors
- Restrictions on hospitals
- Restrictions on Pharmacies
- The costs of your prescription medications
- How much each plan outlines for your out of pocket expense
All of these factors should play a part in making the best decision for your healthcare coverage needs.
Weighing Your Options
When you are weighing the options you have for Medicare Advantage vs. supplement plans, it is important that you do very careful research. This may involve contacting the insurance companies directly and asking them to mail you information regarding the plans they have available.
Do not rush into a decision based on decorative advertisements and catchy phrases you hear online on see on television. Many recipients fall victim to flashy lingo each year, just to back out of their plan between January 1 and February 14, during the Advantage Plan disenrollment period.
If you have any questions about your options, contact CMS or an insurance consultant before making a choice on your insurance coverage.
