Understanding Medicare Advantage and Medicare Supplement Insurance PlansPosted by Medicare Made Clear
Medicare Advantage plans and Medicare supplement insurance plans can both help Medicare beneficiaries get coverage above and beyond what’s offered by Original Medicare (Parts A & B). But each plan works differently and serves a different purpose. It’s important not to confuse them.
Medicare Advantage Plans (Part C)
Run by private insurance companies, a Medicare Advantage plan provides the medical and hospital benefits offered by Original Medicare, 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 health care needs.
For details on any Medicare Advantage plan, call the company that 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, 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 buy a Medicare supplement insurance, or Medigap, plan. Standard plans are available and each offers specific benefits. Plans are labeled by letter in most states and, while all plans with the same letter offer the same benefits, not all plans are available in every state. Also, Massachusetts, Minnesota and Wisconsin standardize plans differently.
Medicare supplement insurance plans 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 Medigap plan. The only exception is if you’re in the process of switching from a Medicare Advantage plan back to Original Medicare and you want to apply for a Medigap plan as well. Many people with Original Medicare also buy a standalone Medicare Part D prescription drug plan.
You must be 65 or older and enrolled in Part B in order to apply for a Medicare supplement insurance plan. Medicare supplement insurance may help pay for Part A deductibles, Part B deductibles, coinsurance, 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 Medigap plan, in addition to the Part B premium that you pay to Medicare.
For more information about Medicare, explore MedicareMadeClear.com or 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.