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Medicare Advantage vs. Medicare Supplement Insurance Plans

by Medicare Advantage Plans:

The federal government’s Original Medicare program helps with the cost of healthcare for most Americans over the age of 65. Inpatient stays in a hospital, physician services, ambulance transportation, medical tests, and preventive screenings are typically eligible for coverage through Original Medicare Part A (hospital insurance) and Part B (medical insurance).

There are additional out-of-pocket medical costs not covered by Original Medicare, including:

  • Part B premiums

  • Deductibles

  • Co-payment or coinsurance

  • Prescription drugs

  • Vision exams and eyeglasses

  • Dental cleanings

  • Emergency care outside of the country

To help make up for some of these gaps in coverage, beneficiaries can enroll in a Medicare Advantage (Part C) or Medicare Supplement Insurance (Medigap) plan.

  • Medicare Advantage is offered through private insurance companies to give consumers a choice in how they receive Original Medicare. These plans cover everything included in Original Medicare Parts A and B, and some may cover additional benefits, such as dental and vision care.

  • Medicare Supplement Insurance, also called Medigap, is an add-on to Original Medicare. It covers Part A and B deductibles, copayments, and coinsurance.

Because you can’t be enrolled in a Medicare Advantage and Medigap plan at the same time, it’s important to understand the differences between these two options when choosing your Medicare coverage.

What’s the Difference between Medicare Advantage and Medicare Supplement Insurance Plans?

How Medicare Advantage works

Choosing a Medicare Advantage plan means you’re enrolling in a plan delivered by a private insurance company instead of the federal government’s Original Medicare program. The companies are contracted by Medicare to deliver these plans and must meet guidelines established by the government.

As part of the contract, all Medicare Advantage plans must cover the same Part A and B benefits as Original Medicare.

They may also provide a range of additional benefits, such as:

  • Prescription drugs

  • Dental cleanings

  • Vision and hearing tests

  • Eyeglasses

  • Hearing aids

  • Transportation to medical appointments

  • Acupuncture

  • Chiropractic care

  • Fitness benefits, such as gym memberships

Benefits, deductibles, coinsurance, and cost-sharing vary depending on the plan.

How Medigap works

If you remain enrolled in the federal government’s Original Medicare plan, you can purchase Medigap or Medicare Supplement Insurance. Medigap plans are sold by private insurance companies and help pay for out-of-pocket costs related to Part A and Part B deductibles, copayments and coinsurance. Some plans may also cover emergency medical care when you travel outside of the country.

Compare Medicare Advantage and Medigap

Here’s a quick comparison of the differences between Medicare Advantage and Medigap. Because plans vary in costs and benefits, be sure to review the details of any plan before purchasing.

Choosing the right plan for you

Once you’ve decided whether Medicare Advantage or Medigap is your best option, you must select the specific plan you wish to purchase.

There are various types of Medicare Advantage plans, including:

  • Health Maintenance Organization (HMO) plans

  • Preferred Provider Organization (PPO) plans

  • Private Fee-for-Service (PFFS) plans

  • Special Needs Plans (SNPs)

You can compare Medicare Advantage plans using Medicare’s online tool.

There are 10 categories of Medigap plans (A, B, C, D, F, G, K, L, M, and N). Each plan within a letter category offers the same basic benefits, regardless of the insurance company selling the policy. You can choose the letter plan that works best for you, and compare plans according to price and additional benefits.

For example, Medigap A plans cover Part A coinsurance and hospital costs, Part B coinsurance, Part A hospice care coinsurance, and the first three pints of blood. Plans within Medigap Plan B cover the above plus the Part A deductible.

This applies in all states except Massachusetts, Minnesota, and Wisconsin, which standardize their plans differently.

Enroll in Medicare

Most Americans qualify for Medicare at age 65. Individuals younger than age 65 who have received certain disability benefits for at least two years, or have end-stage renal disease or Lou Gehrig’s disease, may also be eligible. You can confirm your eligibility using the Medicare online eligibility tool.

Medicare enrollment is handled by Social Security:

  • If you receive Social Security benefits for at least four months before you turn 65, you’re automatically enrolled in Part A and Part B. Your Medicare card should be mailed to you three months before your birthday.

  • If you aren’t receiving Social Security benefits for at least four months before you turn 65, you can call Social Security at 1-800-772-1213, visit a Social Security office, or enroll online.

  • If you’ve received disability benefits from Social Security or the Railroad Retirement Board for at least two years, you’re automatically enrolled in Part A and B and should receive your Medicare card in the mail.

— Article by Medicare Advantage Plans:

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