Medicare Supplement vs. Medicare Advantage
There are two categories of health coverage for individual Medicare insurance:
1. Medicare Supplement (or Medigap) Insurance
2. Medicare Advantage (or MA) Plans.
Medicare Supplement (Medigap) Insurance policies are offered by private insurance companies and work as a secondary to Medicare, paying the majority of the portion of the bill you’d normally have to cover yourself. There are no copays. All plans are standardized by Medicare, but premiums vary by company. You have the freedom to go to any doctor or facility in the US that accepts Medicare, without a referral.
Representing companies such as: UnitedHealthcare®, Blue Cross, Cigna, Aetna/CVS, Mutual of Omaha, Heartland Financial, Americo, Medico, Puritan Life, and more.
Medicare Advantage Plans are also offered by private insurance companies, mostly in the form of HMOs or PPOs, and replace Medicare as the primary insurance. There is a network of providers for each plan and co-pays for most services. Premiums can vary greatly and no two plans are alike. What you’d pay in co-pays is generally less than what you’d have to pay if you had Medicare alone. MA plans may also offer some additional benefits in addition to Medicare, such as: dental, vision, and hearing as well as a fitness club membership.
Representing companies such as: IBC/Keystone65 and Personal Choice65, Aetna, Cigna, UnitedHealthcare®, Health Partners, Humana, Wellcare, Highmark, Geisinger, and more.
Deciding between Medigap and Medicare Advantage
Here are a few simple questions to see if a Medigap or Medicare Advantage plan is right for you.
1. Do you prefer à la carte coverage or a package deal?
Medigap plans pay for the deductibles and coinsurance that come with Original Medicare. But you may need to purchase extra coverage for prescription drug and benefits not covered by Medicare such as dental or vision. Costs can add up but choosing each of your plans lets you personalize your coverage.
Medicare Advantage plans roll all your coverage into one plan, allowing you to make just one decision. Medicare Advantage plans also include extra services and other wellness benefits. As your needs change, you’ll also have the flexibility to change your plan once a year without regard to your age or medical condition. Open enrollment takes place from Oct. 15 through Dec. 7.
2. What is your spending style?
Medigap and Medicare Advantage each use very different approaches to spending. Medigap plans typically have larger monthly premiums, but you’ll pay very little when you visit a provider. It is easy to budget for your health care with Medigap plans. You’ll know exactly how much you’ll be paying each month.
With a Medicare Advantage plan, monthly premiums are typically low. Premiums for each plan are the same for every person, regardless of age or health history. Since you’ll only pay for the health care you use, there will be considerable savings upfront. Yet you will be responsible for copayments and coinsurance, which can be unpredictable from month to month, depending on how often you see your providers. There is a cap on out-of-pocket spending, though most members do not reach that cap.
3. What are your provider needs?
Before deciding on a plan, you’ll want to consider the providers you see as well as your lifestyle. With Medigap, you’ll be free to visit any doctor or hospital in the country as long as they accept Medicare. This is a bonus if you travel a lot, or don’t want to concern yourself with whether your provider is in-network.
Medicare Advantage plans take advantage of a defined provider network, where plans partner with trusted doctors and hospitals to offer you high-quality services at a lower cost. PPO plans may also cover costs for you to visit providers outside of your plan’s network. Seeing in-network providers is usually less expensive, but you may have preferred providers you want to see instead. Either way, we will be sure to check the plan’s provider directory and out-of-network benefits before helping you choose a Medicare Advantage plan to keep your costs to a minimum.
4. Which plan would you prefer long-term?
You’ll also want to consider your long-term needs when selecting a plan.
Many people who select a Medigap plan do so when they first become eligible for Medicare and stay with the same plan over time. This is because you are guaranteed to be accepted at the best rate when you first age into Medicare upon turning 65 or when you start up Part B at retirement. After that, those who want to switch into a Medigap plan or make changes to their plan could result in higher rates or fewer coverage options based on age or new medical conditions.
With Medicare Advantage plans, you have the flexibility to change your plan coverage once a year, and without regard to your age or medical condition. Open enrollment takes place each year from Oct. 15 through Dec. 7.
The best choice is the plan that fits your lifestyle and budget needs. Both are good options, but it’s important to find the right fit for your unique preferences.
1. Medicare Supplement (or Medigap) Insurance
2. Medicare Advantage (or MA) Plans.
Medicare Supplement (Medigap) Insurance policies are offered by private insurance companies and work as a secondary to Medicare, paying the majority of the portion of the bill you’d normally have to cover yourself. There are no copays. All plans are standardized by Medicare, but premiums vary by company. You have the freedom to go to any doctor or facility in the US that accepts Medicare, without a referral.
Representing companies such as: UnitedHealthcare®, Blue Cross, Cigna, Aetna/CVS, Mutual of Omaha, Heartland Financial, Americo, Medico, Puritan Life, and more.
Medicare Advantage Plans are also offered by private insurance companies, mostly in the form of HMOs or PPOs, and replace Medicare as the primary insurance. There is a network of providers for each plan and co-pays for most services. Premiums can vary greatly and no two plans are alike. What you’d pay in co-pays is generally less than what you’d have to pay if you had Medicare alone. MA plans may also offer some additional benefits in addition to Medicare, such as: dental, vision, and hearing as well as a fitness club membership.
Representing companies such as: IBC/Keystone65 and Personal Choice65, Aetna, Cigna, UnitedHealthcare®, Health Partners, Humana, Wellcare, Highmark, Geisinger, and more.
Deciding between Medigap and Medicare Advantage
Here are a few simple questions to see if a Medigap or Medicare Advantage plan is right for you.
1. Do you prefer à la carte coverage or a package deal?
Medigap plans pay for the deductibles and coinsurance that come with Original Medicare. But you may need to purchase extra coverage for prescription drug and benefits not covered by Medicare such as dental or vision. Costs can add up but choosing each of your plans lets you personalize your coverage.
Medicare Advantage plans roll all your coverage into one plan, allowing you to make just one decision. Medicare Advantage plans also include extra services and other wellness benefits. As your needs change, you’ll also have the flexibility to change your plan once a year without regard to your age or medical condition. Open enrollment takes place from Oct. 15 through Dec. 7.
2. What is your spending style?
Medigap and Medicare Advantage each use very different approaches to spending. Medigap plans typically have larger monthly premiums, but you’ll pay very little when you visit a provider. It is easy to budget for your health care with Medigap plans. You’ll know exactly how much you’ll be paying each month.
With a Medicare Advantage plan, monthly premiums are typically low. Premiums for each plan are the same for every person, regardless of age or health history. Since you’ll only pay for the health care you use, there will be considerable savings upfront. Yet you will be responsible for copayments and coinsurance, which can be unpredictable from month to month, depending on how often you see your providers. There is a cap on out-of-pocket spending, though most members do not reach that cap.
3. What are your provider needs?
Before deciding on a plan, you’ll want to consider the providers you see as well as your lifestyle. With Medigap, you’ll be free to visit any doctor or hospital in the country as long as they accept Medicare. This is a bonus if you travel a lot, or don’t want to concern yourself with whether your provider is in-network.
Medicare Advantage plans take advantage of a defined provider network, where plans partner with trusted doctors and hospitals to offer you high-quality services at a lower cost. PPO plans may also cover costs for you to visit providers outside of your plan’s network. Seeing in-network providers is usually less expensive, but you may have preferred providers you want to see instead. Either way, we will be sure to check the plan’s provider directory and out-of-network benefits before helping you choose a Medicare Advantage plan to keep your costs to a minimum.
4. Which plan would you prefer long-term?
You’ll also want to consider your long-term needs when selecting a plan.
Many people who select a Medigap plan do so when they first become eligible for Medicare and stay with the same plan over time. This is because you are guaranteed to be accepted at the best rate when you first age into Medicare upon turning 65 or when you start up Part B at retirement. After that, those who want to switch into a Medigap plan or make changes to their plan could result in higher rates or fewer coverage options based on age or new medical conditions.
With Medicare Advantage plans, you have the flexibility to change your plan coverage once a year, and without regard to your age or medical condition. Open enrollment takes place each year from Oct. 15 through Dec. 7.
The best choice is the plan that fits your lifestyle and budget needs. Both are good options, but it’s important to find the right fit for your unique preferences.
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Prescription Drug CoveragePrescription drug costs are always a major concern for people on Medicare. Medicare Rx Plans can be bundled with an MA plan or you can obtain a stand-alone Part D plan along with your Medigap. Even though all drug plans follow the same four-tier structure, the co-pays and formularies for each plan vary significantly.
Representing companies such as: Aetna/Silverscript, UnitedHealthcare®, Humana, Elixir, Wellcare, and many more. |
