Navigating the Differences: Understanding Medicare Advantage vs. Supplemental Plans

A recent survey indicates that 173 million Americans face financial hardship due to medical debt. Medicare is a helpful option for those over the age of 65.

Original Medicare, i.e., Parts A and B, covers many common health care expenses, but they don’t cover every eventuality. You’ll still have some out-of-pocket costs when you rely on this healthcare insurance alone.

Medicare Advantage and Medicare Supplement plans can help reduce these expenses. 

Read on for a comparison of Medicare Advantage vs. Supplemental Plans.

Medicare Advantage vs. Supplemental Plans

Medicare Advantage offers basic medical and emergency care for seniors. It comprises four parts:

• Part A pays for in-hospital care, care in a nursing facility and limited home care
• Part B covers limited doctor’s services, preventive care, outpatient care, and medical supplies
• Part C or Medicare Advantage
• Part D Supplemental Plans

All American citizens are automatically enrolled in Medicare Part A when they turn 65 years old. Even when combined with Part B, this basic cover excludes necessities like dental procedures, vision care, and prescription drugs.

Original Medicare also doesn’t cover any medical expenses incurred while traveling internationally. You should consider a Medicare Advantage or Medicare supplement plan to help fill these gaps.

Both of these options are offered by private insurers, subject to certain federal provisions. 

What’s Included with Medicare Advantage Plans?

Medicare Advantage plans vary widely depending on which provider you buy them from. They cover a range of medical costs that aren’t included in Original Medicare.

By law, all Advantage plans must provide the same coverage as Original Medicare. They may offer cover for as many additional services as they please.

Most Medicare Advantage Plans cover:

• Medicare Part A
• Medicare Part B
• Medicare Part D

Many of them offer extra coverage for vision, hearing, and dental services. You pay one premium for all the services included in your Medicare Advantage plan. 

When you use services, you pay co-insurance, co-pays, and deductibles. 

What Do Medicare Supplement Plans Cover?

A supplemental plan fills in the gaps left by Original Medicare and some Medicare Advantage plans. They pay the out-of-pocket costs associated with Original Medicare, except prescription medication.

If you want coverage for prescription medication, you must take out a separate Part D drug plan.

There are currently 10 different Medicare supplement plans. These are named after letters of the alphabet, as follows:

• A-D
• F
• G
• K-N

All supplemental plans with the same letter offer the same cover, but they may vary in price depending on who you buy them from. Some states have different requirements regarding what each plan should offer.

With supplement plans, you pay an extra premium on top of your Original Medicare costs. You have limited out-of-pocket costs when you use services. 

Comparing Supplemental Plans and Advantage Plans

Several important differences apply to the care you’re eligible for depending on whether you sign up for a supplemental plan or an Advantage plan.

With supplement plans, you can see any provider as long as they accept Medicare, and you can see specialists without referrals. With Advantage plans, you must use doctors, specialists, and hospitals within a network designated by your insurer.

There are specific times of the year when you can enroll in Advantage plans or switch from one plan to another. You can sign up for a supplement plan any time after you enroll in Plan B, as long as you are 65 years old.

You can opt for prescription drug coverage with some Advantage plans, but you’ll need separate prescription drug insurance if you enroll in a supplement plan.

If a Medicare Advantage carrier does not renew their agreement with Medicare, customers’ policies may lapse, leaving them without any healthcare coverage apart from original Medicare. Should you move out of your plan’s area, you will lose your coverage.

Medicare supplement plans are guaranteed for as long as you pay your premiums.

You can’t cover all your bases by having both an Advantage plan and a supplement plan, but you can switch from one type of plan to another during the annual enrollment period from October 15 to December 7.

How to Choose Between Medicare Supplement and Medicare Advantage Plans

The best choice for your needs depends on a few factors unique to you. Consider the following while comparing your options:

Do you prefer one plan for all your coverage?

A Medicare Advantage plan might suit you best. These plans cover multiple benefits offered by the various parts of Medicare in one policy, and you pay one premium.

With supplement plans, you need to make separate payments for different plans.

Do You Need Long-Term Care or Disability Coverage?

Medicare Advantage will suit you best. Some of these plans offer special needs coverage.

Do You Want to Avoid Unexpected Medical Costs?

Medicare supplement plans protect you from some of the out-of-pocket expenses not covered by Original Medicare. These plans take care of most copays, coinsurance, and deductibles. 

Do You Want Flexibility Regarding Doctors and Service Providers?

When you enroll in a Medicare supplement plan, you can receive treatment anywhere in the USA, as long as the provider accepts Medicare. Some supplement plans will cover you for international travel, too.

Do You Need Coverage for Vision, Dental, or Hearing-related services?

Depending on the specifics, either plan may suit you. Most Advantage plans offer coverage for dental, hearing, and vision treatments. You can also buy additional coverage if you sign up for a Medicare supplement plan.

Get the Help You Need With Medicare

Both Medicare Advantage and Medicare Supplemental plans have their advantages, but neither offers a one-size-fits-all solution. It’s best to get professional help if you’re unsure which is the better option for you.

Midwest Health Insurance Solutions is your one-stop Medicare resource to help you make important decisions regarding all types of insurance. We are committed to helping our clients feel confident about the choices they make, and ready to guide you in the best direction for your needs.

Do you need help comparing the best Medicare Advantage vs. supplemental plans? Our professional staff offers expert, bilingual guidance to help make the best choice for your needs. Let’s make sure you get the insurance coverage that you deserve!