Facts About The Differences Between Medicare Advantage And Supplement Insurance Plans
The differences between Medicare Advantage and Supplement Insurance plans are significant. They are different products and are mutually exclusive. You can’t sign up for both. Both exist to help plan members with medical bills not covered by Medicare. Supplemental coverage helps with these bills. Advantage coverage is private insurance that replaces Medicare and Supplemental coverage.
Everyone is offered Medicare when they reach the age of 65. It’s a 4 part program. Part A is coverage for hospitalization. Part B is coverage for doctor’s visits. Part C allows for beneficiaries to choose private insurance. Part D is coverage for prescription drugs. The government regulates the coverage but doesn’t provide it. Part D coverage has to be purchased separately.
Supplemental insurance (Medigap) is billed after the government has paid it’s covered portion of the bill. Government regulations set the standard options for supplemental policies. Plans are the same no matter where you buy them or who you buy from. Individuals decide which options to purchase. Premiums are pricey and no additional benefits are allowed within this type of coverage. Prescription drug coverage still has to be purchased separately.
Part C allows beneficiaries to elect for private coverage that can offer additional benefits such as vision and dental. Advantage plans maintain a contract with the government receiving payment for the taxpayer funded portion of coverage on a monthly basis. They charge plan members a premium based on the extra benefits they choose.
Most Part C policies offer coverage for prescription drugs, hearing, vision, and dental care, as well as preventive care options. Plan members pay a co-pay and coverage usually starts after a deductible, but premiums are less than those charged for supplemental policies, and additional benefits are available.
Advantage policies do have specific enrollment dates. Part C policies are available when individuals become eligible for Medicare. If they don’t choose Part C at this time, they can still choose to enroll in a Part C policy during open enrollment between 11/15 through 12/31 annually. Part C policies are most often HMO’s but PPO’s can be found also. Advantage policies are easy to qualify for. Many companies offer these policies. A wide choice of benefits and premiums are available to choose from
Supplemental plans are harder to qualify for. There are certain grace periods when they have to accept an applicant. When individuals first become eligible for Medicare they have 6 months to decide. If they choose supplemental coverage at this time they can’t be turned away. Other exceptions provide for individuals to try out private insurance without penalty. If they cancel Part C coverage within 6 months they can enroll in supplemental coverage. An individual dissatisfied with supplemental coverage can switch to private coverage, and change their mind within 6 months, still being eligible for supplemental coverage. Outside these windows, applicants can apply for supplemental coverage all year round, but the medical underwriters do not have to approve the coverage. Beneficiaries can always cancel private policies to return to traditional Medicare with no exceptions.
The federal government provides a benefit guide detailing the benefits and the differences between Medicare Advantage and Supplement Insurance Plans. They also have a website for additional information and contacts. Online insurance sites allow beneficiaries to browse the many plan offerings. Insurance coverage can be confusing. An experienced agent can be a knowledgeable and helpful resource also.
It is very important to fully understand the benefits and costs of the Medicare Advantage or Medicare Supplement Plans that you choose. It is recommended that you call or contact a licensed Insurance Agent or Broker to help you navigate the complex world of Medicare.. Also published at Medicare Advantage And Supplement Plans Which Is Best For You?.
