Medicare Advantage vs. Medicare Supplement
Before making a decision on which Medicare option is best for your specific needs, it’s important to understand the basics of Medicare Advantage (MA) and Medicare Supplement (Medigap) plans. They are very numerous insurance plans with different benefits. The answer to the question "Is one better than the other?" depends on your situation and specific needs.
Medicare Advantage (a.k.a. Medicare Part C)
MAs are health plans offered by private insurance companies that provide the standard hospitalization and medical coverage of Medicare Part A and Part B. In many cases, an MA plan may include additional benefits that are not part of original Medicare such as prescription drug coverage. Medicare Advantage plans may deliver their benefits through one or more of the following plan types:
- Health Maintenance Organization (HMO): A network of health care providers and facilities where you choose a primary care physician to coordinate your care.
- Preferred Provider Organization (PPO): A network of health care providers and facilities where typically you do not need to select a primary care physician and you have more flexible options regarding out-of-network care.
- Private Fee-For-Service (PFFS): A mode of benefit delivery where you are not limited to a network but there are no guarantees that your doctor or hospital will accept the plan.
Medicare Supplement Insurance (a.k.a. Medigap)
A Medicare Supplement plan is an insurance policy designed to pay for certain health care expenses not covered by Medicare Part A and Part B. In every state but Massachusetts, Minnesota, and Wisconsin, there are 10 standardized Medicare Supplement plans (Plans A through N). The 10 plans have different combinations of benefits and deductibles. While Medigap plans always have more benefits than Medicare Part A and Part B, they are no longer allowed to offer prescription drug coverage. Prescription drug coverage can be added through a stand-alone Medicare Part D plan.
The Differences Between Them
The standardized Medigap plans are uniform in the 47 states that offer them. Therefore, a given plan type (e.g. Plan F) has the same benefits regardless of the insurance company that provides the policy or the state in which you reside. On the other hand, Medicare Advantage must provide all Medicare Part A and Part B coverage but, depending on the insurer and the specific plan, may cover more than Part A and Part B benefits. Excluding drug coverage, any standard Medigap plan with Original Medicare Parts A and B will have more benefits than a standard Medicare Advantage program since a Medicare Advantage program is only required to duplicate Medicare Parts A and B benefits. However, as mentioned earlier, some Medicare Advantage programs offer benefits beyond those found in Part A and Part B.
Some Medicare Advantage plans offer prescription drug coverage (often for an additional monthly cost). With a Medigap plan, in contrast, you would need to enroll in a separate prescription drug plan. However, remember that the total cost of drug coverage, as well as coverage for the specific drugs you are taking, is of utmost importance when comparing your options. In some cases, you may find that a Medigap with a stand-alone prescription drug plan has lower total costs than a Medicare Advantage plan with drug coverage. In other cases, the reverse might be true.
When choosing between a Medigap plan and a Medicare Advantage plan, take the time to do your research. Remember that while the benefits of Medigap plans are standardized in the states having plans A through N, their prices are not. Plan F from one insurance company may be significantly cheaper than Plan F from a different company in the same state. Read the benefit descriptions of every Medigap and Medicare Advantage plan you are considering. Be certain to look at:
- Monthly premium
- Doctor and health care facility restrictions
- Anticipated plan costs given your typical use of health care and hospitalization services
- Prescription drug coverage cost sharing as it relates to your medication usage