| Wed, Aug 24, 2011 @ 09:00 AM

Understanding Medicare Advantage (Part C) and Medicare Supplement Insurance (Medigap) Plans

Posted by Medicare Made Clear

Both Medicare Advantage and Medicare Supplement Insurance plans can provide coverage above and beyond what Original Medicare provides.Medicare Advantage (Medicare Part C) and Medicare Supplement Insurance (Medigap) plans can both help Medicare beneficiaries get coverage above and beyond what’s offered by Original Medicare. But each plan works differently and serves a different purpose. It’s important not to confuse them.

Medicare Advantage Plans (Medicare Part C)

Run by private insurance companies, a Medicare Advantage plan provides the medical and hospital benefits offered by Original Medicare (Parts A and B), plus most include prescription drug coverage (Part D). Many plans also offer extra coverage, such as vision, hearing, dental, and health and wellness programs. Medicare Advantage plan members remain enrolled in Original Medicare and continue to pay their Part B premium to Medicare. Some plans also charge an additional premium that is paid to the plan.

There are different types of Medicare Advantage plans: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), Medical Savings Account (MSA) and Special Needs Plans (SNP). Each type has features designed to help meet different member needs.

Make sure you understand how a plan works before enrolling. For details on any Medicare Advantage plan, call the company who offers the plan you’re interested in and request a “Summary of Benefits.” If you didn’t join a Medicare Advantage plan when you were first eligible for Medicare (or you’re enrolled in Medicare and wish to switch plans), you may do so during each year’s Annual Enrollment Period (AEP). In 2011, the AEP runs from October 15 through December 7.

Medicare Supplement Insurance Plans (Medigap)

To help pay some of the costs that Original Medicare doesn’t pay, some people purchase Medicare Supplement Insurance plans, sometimes called “Medigap.” Ten standard plans are available, labeled “A” through “N,” and each offers specific benefits. All plans with the same letter offer the same benefits, except in Massachusetts, Minnesota and Wisconsin, which have defined their own plans. Not all plans are available in every state, and plans E, H, I and J are no longer offered to new enrollees.

Medicare Supplement Insurance plans help fill the gaps in coverage under Medicare Parts A and B. They are designed to be used in conjunction with Original Medicare. If you’re enrolled in a Medicare Advantage plan, then you do not need—and an agent cannot sell you—a Medicare Supplement Insurance plan. The only exception is if you’re in the process of switching plans and resuming coverage under Original Medicare, and you want to apply for a Medicare Supplement Insurance plan as well.

You must be 65 or older and enrolled in Part B in order to apply for a Medicare Supplement Insurance plan. Medicare Supplement Insurance helps pay for Part A deductibles, Part B deductibles, coinsurance and providers’ excess charges, the cost of blood transfusions, additional hospital days after you’ve used up your Part A benefits, and more. For a complete list of benefits, contact the insurance company that sells the plans you’re interested in. You’ll pay a premium for a Medicare Supplement plan, in addition to the Part B premium that you pay to Medicare.

For more information contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact UnitedHealthcare® Medicare Made Clear to learn more at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.

Resources:

Watch a video about Medicare Advantage plans.

Watch a video about Medicare Supplement Insurance plans.

Download Medicare.gov’s Medicare & You handbook.

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