Medicare Supplement VS Medicare Advantage Review means knowing the difference before choosing between the two. Basically, Medicare is a familiar program for most people especially seniors. In fact, it has been around since 1965. Medicare Supplement and Part C Medicare provide medical assistance. However, they both have differences when it comes to the price. Also, both cover different medical services. Further, this article will help you distinguish difference between the two. In addition, it will give you an idea which option is best.
What is Medicare? (A Review)
It is important to know the basics of Medicare before reading Medicare Supplement VS Medicare Advantage Review. Medicare is a federal government program that aims to provide health care coverage or health insurance. For instance, when you are 65 or older, you can receive Medicare services. In other cases, people under 65 with certain diseases can also receive Medicare coverage. Also, it includes a myriad of coverage, rules, regulations and policies. Basically, it has Four (4) Parts where Part A and Part B is inclusive in Original Medicare.
Once a person becomes eligible, they can enroll in Original Medicare. Also, this is the traditional fee-for-service program. The federal government offers this directly. Moreover, Original Medicare has two parts: Part A and Part B.
Part A Medicare (Hospital Insurance)
This Part covers inpatient hospital stays. Also, it includes care in a skilled nursing facility, hospice care and home health care.
Part B Medicare (Medical Insurance)
Part B Medicare covers certain doctor’s services. Also, it includes outpatient care, medical supplies, and preventive services.
Part C Medicare (Medicare Advantage Plans)
Part C is another option to Original Medicare. Further, Medicare insurance companies provide this health care plan. They have contracts with Medicare, giving eligible individuals both Part A and B benefits. Medicare health insurance plans include HMO, PPO, and others. Remember, these insurance companies have approval with Medicare. If you enroll in Part C, most services are covered through the plan. In addition, you are not paid for under Original Medicare. Moreover, most Part C Medicare offer prescription drug coverage.
You must also differentiate Medicare Supplement VS Medicare Advantage Review. This helps you know which is best for your health and medical needs.
Part D Medicare (Prescription Drug Coverage)
Finally, Part D includes prescription drug coverage to Original Medicare. Also, it includes some Medicare Cost Plans, Medicare Private-Fee-for-Service Plans and Medicare Medical Savings Account Plans. Insurance companies and other Medicare insurance companies offer this coverage. Some Medicare Advantage Plans also offer prescription drug coverage. In fact, they also abide to the same rules as Medicare Part D. Moreover, this is a separate policy which one buys from a private insurance.
Medicare Supplement VS Medicare Advantage Review – Which is Better?
You must remember that Original Medicare is not free. A requirement is paying some health care costs out of your own pocket. For example, eligible under Original Medicare pays deductibles for every hospital stays. Also, they must pay 20% of the cost of most outpatient treatments. This includes doctor visits. Unlike private insurances, Medicare has no limits when it comes to spending out of your own pocket. In fact, bills can stack up quickly. Especially, if you are in need of expensive treatments like outpatient chemotherapy.
What is Medicare Supplement?
Most agents call Medicare Supplement as Medigap. Medicare supplement quotes protect people from buying traditional Medicare costs. In exchange, Medigap charges a premium in addition to one’s payment for Medicare Part A, B, and sometimes D.
It becomes more confusing. Medicare supplement quotes also involves plans sorted with letters. The plans available are A, B, C, D, F, G, K, L, M, and N. That makes it sound tedious, doesn’t it? However, the type of plan with the same letter must provide the same set of basic benefits. That is, also regardless of the location.
People consider Medigap to help pay for most health-care services and supplies. Unlike Original Medicare, only private insurance companies offer Medigap. These Medigap plans does not only assist in paying hospital and medical costs. They also cover copayments, coinsurance and yearly deductibles.
Medicare Supplement quotes also help pay other medical services. This includes emergency overseas travel coverage. Also, it may include Part B excess charges. Two out of the ten Medigap plans include a yearly out-of-pocket limit. Take note that those limits are not included in Original Medicare. So basically, Medigap policy covers the “gaps” in Original Medicare.
How does Medigap work with Medicare?
As the term suggests, Medigap supplements your Original Medicare benefits. Therefore, some policies are called Medicare supplement plans. You must enroll for Original Medicare to become eligible for Medigap coverage. Meanwhile, you must also stay enrolled in Original Medicare. This is for your hospital and medical coverage. Further, Medicare supplement quotes do not exist to provide stand-alone benefits.
You can get Medigap depending on the state you live in. People under 65 with disabilities may not get Medigap coverage. Some states do not offer Medigap coverage to beneficiaries under 65. You should check with your state’s insurance department. This way, you will find out if you are eligible to enroll in a Medigap plan.
Prescription Drug Coverage Not Included
Medicare Supplement does not include prescription drug coverage. So, you must enroll in Medicare health insurance plans that include part D if you wish assistance for that coverage. Moreover, you can’t use Medigap to pay for costs you have with Part C Medicare. In fact, you may only use Medigap to cover costs in Original Medicare.
Filling the coverage gaps/holes
For instance, you have both Original Medicare and Medigap plan. Original Medicare pays first. Then, Medigap policy will fill in the cost gaps. For instance, you have a $5,000 medical bill and they meet the yearly Medicare Part B deductible. Part B pays 80% of the medical bill. Then, Medigap covers Part B copayments and coinsurance costs. Therefore, Medigap policy pays 20% coinsurance of the $5,000 medical bill. Moreover, some Medigap plans cover Part B deductible.
Coverage gaps mean leaving you with tens of thousands of hospital bills. That is practically a bad health year. Therefore, most people purchase Medicare supplement insurance.
What types of coverage are not included in Medicare Supplement Plans?
Those eligible may also enroll in other types of coverage. These are either through Medicare program or other sources. Such as, coverage from an employer. One fills out the Initial Enrollment Questionnaire when they first sign up for Original Medicare. The questionnaire asks whether they already have other types of insurance. It is essential to include all types of coverage they have. This information will help Medicare decide who pays first when one receives healthcare services.
The following are types of Medicare health insurance plans a person may have. Take note that they are different from Medicare Supplement:
- Medicare Advantage Plans (HMO, PPO, etc.)
- Medicare Part D (Prescription Drug Plans)
- Veteran’s benefits
- Group coverage from an Employer or union
- Policies from long-term care Medicare insurance companies
What benefits do Medigap cover?
At present, there are 10 standardized Medigap plans. Each of these represents a letter. They are available in most states. Such as, Minnesota, Wisonsin and Massachusetts. Each state has their own different set of standardized Medigap plans.
Coverage and premium levels may vary. However, the benefits of each plan within a category stay the same. Yes, despite the location and Medicare insurance companies.
For instance, the benefits of Plan A are similar in New Jersey as in Oregon. If a Medigap offers a certain benefit, they cover this 100% unless specified otherwise.
Generally, Medicare Supplement plans cover the following benefits:
- Medicare Part A coinsurance and hospital costs (includes additional 35 days after using Medicare benefits)
- Medicare Part B coinsurance or copayment
- First 3 pints of Blood
- Part A hospice care copayments or coinsurance
Other types of Medigap plans also cover:
- Coinsurance for skilled nursing facility care
- Part A Medicare deductible
- Part B Medicare deductible
- Excess charges of Medicare Part B
- Overseas travel emergency (limits depend on the plan)
Comparing Benefits of Medigap Plans
Basically, Medigap Plan F is the most popular plan. They offer almost an all-inclusive coverage.
Medigap Plan G offers all the same benefits as Plan F excluding Part B deductible.
Two Medigap Plans (K and L) include an out-of-pocket limit. This is when Medicare services and reaches a limit. Medigap then covers 100% of the costs for the rest of the year.
Benefits of Medigap Plan M are the same as Plan D. However, they pay half of Part A Medicare deductible.
Meanwhile, Medigap Plan N covers the same benefits as Plan F. Although, it excludes Part B deductibles and excess charges. Study the chart below to further understand Medigap Plans.
|Medigap Benefits||Medigap Plans for Most States|
|Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B Medicare coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes**|
|First three pints of blood||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A Medicare hospice coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled Nursing Facility (SNF) coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A Medicare Deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B Medicare Deductible||No||No||Yes||No||Yes||No||No||No||No||No|
|Part B Medicare Excess Charges||No||No||No||No||Yes||Yes||No||No||No||No|
|Overseas Travel Emergency||No||No||80%||80%||80%||80%||No||No||80%||80%|
What is Medicare Advantage Plan?
Most people call Medicare Advantage Plan as Medicare Part C. Basically, it provides more assistance at a lower cost. Further, it covers a lot of services than Medicare plus Medigap. Instead of paying or Parts A, B, and D, one may enroll in Medicare health insurance plans. These companies provide everything: Part A, B, and D. In addition, they offer additional services such as dental, vision and hearing.
Medicare Advantage plan means getting both benefits in Part A and Part B Medicare. Part C plans are like private health insurance plans. Most plans include services like office visits, lab tests, surgery and many others. Part C provides medical coverage beyond Part A and B. Some Medicare health insurance plans include prescription drug in Part C.
Part C Medicare is not a separate benefit. This is a Medicare policy which allows private health companies to provide benefits. Actually, eligible you may choose Medicare coverage through Medicare Part C instead of Original Medicare.
Furthermore, Medicare Part C plans must offer benefits same as Original Medicare. Also, they can do so with their own costs, rules and coverage restrictions. They may also get Part D as part of their Part C benefits package.
How does Medicare Part C work with Medicare?
Medicare Part C must cover services similar to Original Medicare. You may still get Original Medicare coverage if you have MA Plans. For instance, hospice care and other clinical benefits. Medicare Advantage Plans always cover emergency and urgent needed care.
Furthermore, the plan may choose not to cover costs that are not necessary. You should consult with your provider before getting the service you want and need.
Usually, MA plans cover extra coverage such as vision, dental, hearing and other wellness programs. Most plans include Part D.
Costs of Part C Medicare
You will be responsible for paying Part B premiums. This ranges from $96.40 to $308.30. It depends on your income too. In addition, you don’t have to pay an extra premium but depends on the chosen plan. Actually, the government sponsors Part C. Extra services inclusive in the plan may drive up costs. Basically, the costs are as follows:
- Youmust qualify for Part A and Part Medicare to get Medicare Part C. This means, you must at least pay a Part B premium. The standard Part B premium is $134 per month. Also, expect there will be increases in 2018.
- The cutoff income amount for standard premium is $85,000. If you have a higher income, you may generally have to pay a higher premium.
- Deductible costs $183 per year. This may increase in 2018.
- You also pay a 20% coinsurance or 20% of all medical costs.
- Part C Medicare has additional costs. This means one pays a monthly premium for it as well. Also, these premiums vary but can be as low as $46 per month. The Centers for Medicare and Medicaid Services announces a decrease in 2018. It is an average of $30 a month.
Medicare Part C Cost Sharing
Costs always matter when understanding Medicare Supplement VS Medicare Advantage Review. Most MA plans include co-insurance, deductibles and co-payments. These share the costs of one’s services. Cost-sharing applies to most of the services the plan covers.
Further, most Part C plans have network hospitals and doctors. These offer plan members prices with discounts. Every Part C plan has specific costs. However, it has similar types of costs. The table below explains the types of costs.
|Premium||Monthly premiums may vary. You must still pay the Part B premium to Medicare. Also, Part A premium if you have it.|
|Deductible||You will pay this every year. Some plans charge annual deductibles. Some do not. Moreover, Part A and B deductibles do not apply.|
|Co-Payment||Most plans charge co-payments for medical services and additional benefits. E.g. doctor visits|
|Co-Insurance||Plans set their own co-insurance terms and percentages. This includes additional services such as durable medical equipment.|
Medicare Supplement vs Medicare Advantage Review – Which is Better?
Medicare Supplement VS Medicare Advantage Review helps you choose better. It is illegal for Medicare insurance companies to sell both Part C and Medigap. There are three things to consider when choosing: cost, network, and lifestyle.
Medigap has a higher monthly premium. In fact, most seniors can’t afford this because prices are over at least $130 a month. This is probably the disadvantage of Medicare Supplement. Further, it does not include vision, dental and hearing. Moreover, one must purchase Part D separately. Medigap offers a few benefits at a higher cost.
However, the advantage of Medigap is lower out-of-pocket expenses. Medigap covers the gaps which Original Medicare does not cover. This is where all the expensive monthly premiums pay off.
Meanwhile, Medicare generally costs less. Also, they cover more services. Therefore, this is the best option for most seniors’ budget.
Medicare Part usually has zero premiums. It costs at least $40 per month. Medicare Advantage also work with extra help. This way, the state or social security can help pay the coinsurance, copayments and other fees.
Medicare Part C generally has limitations within doctors and facilities. For instance, HMO or PPO may not cover any out-of-network care. However, Medigap policies help cover any doctor or facilities that accept Medicare. This is the biggest advantage of Medicare supplement. Further, patients may see any doctor or hospital in the nation. Moreover, they may see promising specialists and Medigap helps pay for the costs.
Medicare Part C often only operate within certain regions. Further, one cannot use Medicare Part C outside their state. However, a frequent traveler may do better with Medigap. Moreover, Medigap provides coverage when traveling outside one’s state, and overseas. Further, Medigap includes coverage in all 50 states. Generally, Medicare Part C do not include this benefit.
To further understand Medicare Supplement VS Medicare Advantage Review, study the comparison chart below:
|Medicare Supplement||Medicare Advantage|
|How it works with Original Medicare||Medigap pays all or most Part A & B out-of-pocket costs.||Medicare insurance plans cover Part A & B benefits directly in place of Original Medicare.|
|Premium||Costs may be about $150 to $350 a month. Can vary by age, health history, or both.||$0 to more than $60 a month depending on the plan. All enrollees pay the same.|
|Out-of-pocket payments||Low to none (excluding premium).||In-network medical deductibles and co-payments vary from $3,400 to $6,700 a year. It depends on the plan.|
|Choice of doctors and hospitals||Any doctors and hospitals under Medicare||HMOs: Providers under their network only.
PPOs: Any provider. However, out-of-network providers are more expensive.
|Part D (drug) coverage||Excluded. One must purchase a separate Part D plan.||Most plans include Part D coverage.|
Medicare Supplement VS Medicare Advantage Review can be so confusing. Also, both have benefits and disadvantages. Medicare Part C offers a myriad of benefits including hearing, vision, and dental. However, patients may only choose doctors and facilities under their network. If they go for other doctors, they will have to pay for the costs. Meanwhile, Medigap can be expensive. But, they cover expenses which Original Medicare do not cover. This helps patients pay for remaining medical expenses. Further, Medigap covers overseas medical treatment. Understanding their differences will help one choose which is best for their budget and lifestyle.