Medicare Advantage vs. Medicare Supplements: What to choose?

Beyond Original Medicare, there are Medicare Advantage (Part C) and Medicare Supplement (Medigap) plans. These help to 1) offer additional coverage and 2) cover expenses leftover from Medicare. Unfortunately, you cannot have both a Part C and a Medigap plan. If you need help affording Medicare, look into Medicare Supplement plans. If you need more coverage than Medicare can give you, try a Medicare Advantage plan. Each plan has its benefits, and it is best to compare costs based on your coverage needs.

Medicare Advantage plans

Medicare Advantage plans, often called Part C, carry the same coverage of Original Medicare Parts A and B. Most plans also have prescription drug coverage and may offer extras such as vision, dental, or hearing coverage. Part C plans come in a few common forms. These include HMOs, PPOs, PFFS plans, and SNP plans.

Health Management Organization (HMO) plans require you to receive care from providers in the plan’s network. If the service is out-of-network, you pay the full cost, unless for emergency care, out-of-area urgent care, or out-of-area dialysis. Most HMO plans require you to have a primary care doctor and require referrals to see specialists for most services. Many plans offer prescription drug coverage.

Preferred Provider Organization (PPO) plans have you pay more for using the services of doctors, hospitals, and other providers that are out of network. Many plans offer prescription drug coverage. You can go to any doctor, hospital, or healthcare provider that is in-network and do not need a primary care doctor. You do not need a referral to see specialists, but in-network specialists will be less costly.

Private Fee-for-Service (PFFS) Plans determine how much they pay health care providers and what you owe. You may pay more for out of network services if the plan has a network. You can receive treatment from any healthcare provider that agrees with the plan’s payment terms and agrees to treat you. You do not need a primary care doctor or a referral to see a specialist. Some plans may not offer drug coverage.

Medicare Special Needs Plans (SNPs) are limited to people with chronic conditions, those living in institutions, or those who are dual-eligible with Medicare and Medicaid. All SNPs carry prescription drug coverage. Most SNPs require a primary care doctor and referrals for specialists.

Medicare Supplement plans

Medicare Supplement plans are designed to cover the expenses you have left to pay after Medicare pays their share. These are for the costs of Medicare Part A and Part B, including the deductible, copayments, and coinsurance. The only cost Medigap plans cannot pay is the Part B deductible.

Which is the right plan for you? A licensed insurance professional can help you find what you’re looking for.

For all of your Medicare questions, check with Medicare on Video.

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