Medicare is health insurance offered by the Federal government to people who are 65 or older, people under age 65 with certain disabilities, and people of any age with End Stage Renal Disease (ESRD) - permanent kidney failure requiring dialysis or a kidney transplant) , who meet the eligibility requirements. Medicare helps pay for health care, but does not cover all medical expenses. The United States Medicare system is managed by the Centers for Medicare & Medicaid Services. Read these articles to determine your eligibility. Original or “traditional” medicare is a pay-per-service program offered from the federal government. They pay up to 80% of the medicare-approved amount directly to the doctors that accept medicare for the health care services you receive. Original medicare provides Part A and B commonly referred to as Hospital and medical insurance.
Medicare Advantage plans, or medicare part C. incorporates the standard medicare parts A & B and goes above and beyond by offering other services like vision, dental, hearing and/or wellness programs, most of these plans include prescription drug coverage or Medicare part D. However each medicare advantage plan can charge different out of pocket amounts in addition to your medicare part B premium. Medicare Supplement Plans covers the cost of what original Medicare does not cover, usually up to 100%.
Medicare Advantage vs. Medicare Supplement
Before you can make a decision on which Medicare option is best for your needs, you must first understand the basics of Medicare Advantage (MA) and Medicare Supplement (Medigap) plans. They are very different insurance plans with distinct benefits. "Is one better than the other?" depends on your circumstances and needs.
Medicare Advantage (MA)
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 some cases, a 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 options. A health maintenance organization (HMO) is a network of health care providers and facilities where you choose a primary care physician to coordinate your care. A preferred provider organization (PPO) is also a network of health care providers and facilities but typically you do not need to select a primary care physician and you have more flexible options regarding out-of-network care. A private fee-for-service (PFFS) is 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 (Medigap)
A Medigap plan is an insurance policy designed to pay for certain healthcare expenses not covered by Medicare Part A and Part B. In every state but Massachusetts, Minnesota, and Wisconsin, there are ten standardized Medicare Supplement plans (Plans A through N). The ten plans have different combinations of benefits and deductibles that can be reviewed on our Medicare Supplement page. 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.
What's the Difference Between the Two?
The standardized Medigap plans are uniform in the 47 states that offer them. Consequently, 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 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 & B will have more benefits than a standard Medicare Advantage program since a Medicare Advantage program is only required to duplicate Medicare Part A & 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.
Comparison Is Key
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 healthcare facility restrictions
- Anticipated plan costs given your typical use of healthcare and hospitalization services
- Prescription drug coverage cost sharing as it relates to your medication usage