If you’re looking into getting Medicare, all the information can certainly feel overwhelming. There are many different plans and benefits to choose from. One of the many decisions that you’ll have to make when choosing Medicare plans is deciding which plan you want. Do you want Original Medicare plus a Medicare Supplement plan or a Medicare Advantage plan? If you’re unfamiliar with the way Medicare works you might be wondering: what’s the difference?
Well, to understand the difference between these two types of plans, you first need to understand what each of these types of plans includes. This article breaks down what you’ll get when you enroll in a Medicare Advantage plan, and what you’ll get if you decide to go with Original Medicare plus a Medicare Supplement plan.
Medicare Advantage Plans
A Medicare Advantage plan is like a bundle of Medicare coverage through a private insurer. These types of plans will typically cover Original Medicare and prescription drugs.
Original Medicare covers medical expenses incurred while in the hospital (Part A) as well as other outpatient services (Part B). This typically includes many different services and pieces of medical equipment that you need. These might be things such as basic fitness programs, rehabilitation, physical therapy, speech-language pathology, wheelchair ramps, shower railings, etc.
Some Medicare Advantage Programs include Medicare Part D. Medicare Part D is Prescription Drug Coverage. With this coverage you’ll only have to pay for a certain percentage of your prescription medications out of pocket.
All of these things combined are covered in most Medicare Advantage plans. If you sign up for another type of Part D plan while enrolled in a Medicare Advantage plan you are removed from your Medicare Advantage plan. After being removed you are signed up for Original Medicare.
Supplemental Medicare Plans
Medicare Supplement plans are designed to work alongside Original Medicare to help cover out of pocket costs. So, if you sign up for a Medicare Advantage plan, you won’t be able to enroll in a Supplemental Medicare Plan at the same time.
These plans are sometimes referred to as Medigap plans. They are designed to cover gaps that your Original Medicare does not. But Medicare Supplement plans don’t provide any stand-alone coverage, so you’ll need to be enrolled with Medicare Part A and Part B coverage in order to have one. Your Medicare Supplement plan will help cover the out of pocket costs that Part A and Part B won’t cover such as, your required coinsurance, copayments or deductibles. Supplement plans will also cover emergency medical coverage when travelling out of the country.
In most states, you’ll have 10 different Medicare Supplement plans to choose from. Premium costs for these plans may vary depending on the insurance company you go through. The prices may also change according to where you live. For example, the states of Wisconsin, Massachusetts and Minnesota standardize their Medicare Supplemental plans differently from the rest of the United States.
If you’re interested in having dental, vision or hearing coverage be aware that Medicare Supplement plans do not cover these items beyond what’s already included in your Medicare Part A and Part B plan.
One significant difference between having a Medicare Advantage plan and having Original Medicare plus a Medicare Supplement plan is that prescription drug coverage is not included. If you would like to have prescription drug coverage, you’ll need to sign up for a stand-alone coverage plan to assist covering the costs of your prescription drugs. If you sign up for a Medicare Advantage Prescription Drug plan you have the convenience of all of your medical insurance coverage benefits administered through a single Medicare plan.
Another big difference between Medicare Advantage plans and Medicare Supplement plans is your ability to change your plan. While you have the option in enrolling in a different Medicare Advantage plan twice a year during two different open enrollment periods, Medicare Supplement plans only allow you to enroll once in your lifetime unless you have special circumstances.
The third difference between these two types of plans is in regard to network restrictions. When you enroll in a Medicare Advantage plan, you commit to a network. This network reserves the right to restrict the providers you can choose from. On the other hand, if you choose to sign up for an Original Medicare plan and a Medicare Supplement plan, you’ll face no such restrictions. Additionally, Medicate Supplement plans are accepted wherever Medicare is accepted. Medicare Advantage has more restrictions on it and are not as widely accepted.
No matter which plan you decide to sign up for, is you’ll pay a premium for Medicare Part B. This rule is consistent across Medicare plans because Medicare Part B covers so many items and services.
If you’re still not sure about which type of plan is best for you, give your insurance agent a call. They will be able to talk you through your options to help you come to an informed decision.