 Advantage or Supplement...
Which plan is right for me?
Both Medicare Supplements and Advantage plans have their pros and cons, and selecting the right plan for your situation is a crucial part as you move into Medicare.
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Below you will find a chart separating the characteristics of Medicare Advantage and Medicare supplement plans.
Here is a summary. A Medicare Advantage could be a good fit for you if you want extra benefits such as dental, vision, hearing, gym membership, and Rx (Part D) coverage, all included in one plan (depending on the plans available in your area) for a $0 monthly premium. The negative characteristic about these plans is they are typically HMO's, and you will need to use network providers.
A Medicare Supplement plan could be a good fit for you if you want to see any doctor or facility you wish (as long as they accept Original Medicare) anywhere in the country without referrals. The negative characteristic about these plans is you will have a monthly premium, and these plans do not include Rx (Part D) coverage.
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Medicare Advantage
Medicare Supplement
Eligibility
You must have Part A and B of Medicare.
You must live in the plan's service area.
The plan must accept all eligible applicants other than those with end-stage renal disease.
Must have Part A and B of Original Medicare.
Enrollment is guaranteed during your open enrollment period or if you qualify for other guaranteed issue rights.
Signing up outside of open enrollment or guaranteed issue period means that companies are allowed to use medical underwriting to determine whether to except your application and the premium amount you will be charged.
Generally Medigap open enrollment period is a six-month window that begins the month you enroll into Medicare part B.
Costs
Plan costs and copays will vary based on where you live.
Advantage plan premiums are typically much lower than supplement insurance premiums and many have a $0 monthly premium.
Most plans include co-pays, coinsurance, a maximum-out-of-pocket amount, and additional benefits not usually covered by Original Medicare.
Premiums may vary due to age, gender, tobacco use, zip code, and health (if you are not in a guaranteed issue or open enrollment period).
Premiums for the same plan may vary from company to company.
Generally there are no copayment costs (determined by the plan you select) from Medicare covered services at the time of service.
Network & Provider Choice
Most plans will include a network of hospitals, doctors, and other providers.
It is important to make sure the plan you select covers your current providers and facilities.
Most plans allow you to see any doctor or health care provider nationwide that excepts original Medicare.
Some Medicare Select plans might require you to use a doctor in the Plans network.
Prescription Drug Coverage
Most Medicare Advantage plans include prescription drug coverage.
Standalone Medicare Advantage plans are available for those with other qualifying drug coverage.
Drug coverage can no longer be included in a Medicare Supplement policy sold today.
Most people who choose supplement policies elect to take a stand-alone Part D prescription drug Rx plan (PDP) in addition to their supplement plan.
Do Benefits change? Is the plan Renewable?
Plan benefits and networks can change annually.
You are able to change coverage yearly during the Annual Election Period (AEP 10/15 to 12/7) and most Medicare beneficiaries can also change during the MA Open Enrollment Period (OEP 1/1 to 3/31).
You will usually be automatically re-enrolled in your plan each year unless you choose to disenroll or switch your coverage.
Supplement plans are guaranteed renewable as long as you pay the premiums.
There is no Annual Election Period for Medigap plans which means you are able to switch coverage at any time during the year.
Coverage changes made after your initial enrollment usually require medical underwriting.
Extra Benefits
Some plans will include extra benefits such as vision, dental, hearing, gym memberships, and more. Most plans provide world wide emergency coverage.
Some plans include benefits for coverage while traveling outside the USA and a few provide gym memberships or discounts.
Which plan is right for me?
If you value a low monthly premium.
If you value one carrier for your Health and Prescription Drug Rx coverage.
If you value one ID card for all your Healthcare and Rx needs.
If you value the option to see any provider that excepts original Medicare nationwide.
If you travel frequently or have a second home in a different state.
If you value a predictable healthcare budget.
Could save you money if you have high-cost or frequent healthcare needs.
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