For decades, we’ve been by your side, helping thousands navigate the ins and outs of Medicare enrollment.
Along the way, one thing that consistently surprises people is that Medicare isn’t free.
It often falls short on crucial services like dental, vision, and hearing aids—essentials for staying healthy and happy in your golden years.
It’s a gap we’re here to bridge, ensuring you get the coverage you truly need.
Why do I Need to Supplement my Medicare?
In addition to the continually increasing cost of Medicare (approximately $170.10 per month for Part B in 2024), essential services like dental, vision, and hearing aids often aren’t covered.
Medicare’s prescription drug coverage is also limited, highlighting the importance of Part D for many beneficiaries.
Medicare Advantage Plans and Medicare Supplement Plans are the two most reliable and cost-effective ways to bridge these gaps.
Today, we will compare Medicare Advantage Plans vs. Medicare Supplement Plans. We will talk about everything from costs to coverage, so you can make an informed decision that fits your needs.
How to Decide Between Medicare Advantage Plans & Medicare Supplement Plans
Advantage plans and supplement plans are not designed to work together, so it’s necessary to pick only one.
Here are a few questions that you can ask yourself that will help inform the decision:
- Are you willing to choose from a provider network, or do you need to choose your own provider?
- Would you rather pay higher monthly premiums with low out-of-pocket costs, or a $0 premium with higher copays and out-of-pocket costs?
- Do you want prescription drug coverage included in your plan, or would you prefer to buy it separately?
Once you know the answers to these questions, choosing between Medicare Advantage and Medicare Supplement is quite simple.
Medicare Supplement Plans – Low-Out-of-Pocket Costs
Medicare Supplement Plans, also known as Medigap, are invaluable for covering expenses that Original Medicare doesn’t fully pay.
These plans help with coinsurance, copayments, and deductibles, offering peace of mind by reducing your out-of-pocket costs.
Certain Medigap plans also extend coverage to services like medical care received outside the United States, which Medicare typically doesn’t cover.
To enroll in a Medicare Supplement plan, you pay a monthly premium to a private insurance company. This premium is in addition to your monthly Part B premium, which is required for all Medigap plans.
By supplementing Medicare with a Medigap plan, you gain comprehensive coverage and financial protection, ensuring that your healthcare needs are met without unexpected expenses.
Who Is Eligible for Medicare Supplement?
If you’re turning 65 and enrolled in Medicare Part B, you have a six-month open enrollment period.
This period begins on the first day of the month you turn 65 or older and enroll in Part B.
For example, if you turn 65 in July and enroll in Part B during that month, your optimal time to purchase a Medigap policy is from July to December.
This window is brief but significant because it’s the only time you’re guaranteed to get a Medigap policy without undergoing medical underwriting.
This means insurers cannot deny you coverage or charge higher premiums based on preexisting health conditions.
Enrolling during this period ensures you can secure the Medigap coverage that best suits your needs right from the start of your Medicare eligibility.
The Pros & Cons of Medicare Supplement Plans
PROS:
- You can use choose any doctor or provider that accepts Medicare
- Very low out-of-pockets costs (varies by plan)Guaranteed renewable, even if you develop health problems
CONS:
- Tends to be more expensive than Medicare Advantage
- Prescription coverage is not included (making Part D a necessary add-on)
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Medicare Advantage Plans – Comprehensive Coverage with Low Premiums
Medicare Advantage plans offer a wide array of choices, including HMOs, PPOs, PPFDs, and SNPs, among others.
Your Personal Benefits Manager can clarify the differences, but the key takeaway is that Medicare Advantage (or Medicare Part C) provides flexible and comprehensive coverage options.
These plans often feature low to zero-dollar premiums, making them an attractive alternative to traditional Medicare.
While they may have higher copays and deductibles, many Medicare Advantage plans include dental and vision coverage, which are not typically covered by Original Medicare.
Additionally, they provide a significant upgrade with an out-of-pocket cap, ensuring financial protection for unexpected healthcare costs.
Overall, Medicare Advantage plans offer a more cost-effective solution compared to combining a Supplement Plan and Part D for similar coverage.
They provide the convenience of integrated benefits and potentially lower overall healthcare expenses, making them a popular choice among Medicare beneficiaries.
Who Qualifies for Medicare Advantage?
Medicare Advantage is generally available to:
- Seniors aged 65 and older
- Individuals with disabilities, regardless of age
- People with end-stage renal disease (permanent kidney failure requiring dialysis or transplant)
To enroll in a Medicare Advantage plan, you must also be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance), and you must live within the plan’s service area.
Enrollment typically happens during specific periods, but you cannot be turned down due to a preexisting condition. You have three key times to join or switch to a Medicare Advantage plan:
- Initial Medicare Enrollment Period: Starts three months before you turn 65 and ends three months after.
- Annual Open Enrollment Period: Runs from October 15 to December 7 each year.
- Medicare Advantage Open Enrollment Period: Occurs annually from January 1 to March 31.
The Pros & Cons of Medicare Advantage Plans
PROS:
- Some plans are available with $0 premiums
- Prescription drug coverage is included with most plans
- $8,850 out-of-pocket cap for in-network coverage ($13,300 out-of-network)
CONS:
- Must in-network doctors and hospitals
- Co-pays and deductibles required for health care services
Expand Your Medicare – Call Today
In summary, Medicare Advantage offers comprehensive coverage in a single plan and can lead to long-term cost savings compared to a combination of Medigap and Part D.
Medigap plans provide more flexibility in choosing healthcare providers, minimal out-of-pocket expenses at point-of-care, and predictable coverage without network restrictions. They are ideal for individuals who prioritize freedom of choice and want to avoid unexpected medical costs.
As you can probably imagine, there is a lot more to these plans than meets the eye. Your Personal Benefits Manager can help you understand the details so you can make the right choice. Call today at 1-800-913-3416 to talk to us, or visit MediGap Advisors to schedule a free consultation.
Further Reading:
Get a Free Medicare Advantage Quote
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage.