Medicare Supplement Plans, also called Medigap plans or policies, are plans sold by private insurance companies that help fill the gaps in your Original Medicare coverage. Supplement plans help cover costs that Original Medicare leaves to you, like coinsurance, deductibles, and copayments.
Depending on where you live, you may have up to 10 different Medigap plans to choose from. Each plan is identified by a letter: Medigap A, B, C, D, F, G, K, L, M, and N. Plans offered in your state depend on your state’s laws as well as individual insurance companies.
All Medigap plans offer the same basic benefits:
- Part A coinsurance and hospital costs
- Coverage for the Part B coinsurance or copayment
- Coverage for the first three pints of blood used in a procedure
- Coverage for your Part A hospice care coinsurance or copayment
Some plans also cover some or all of the following:
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible
- Part B excess charges
- 80% of foreign travel emergency care
What Is Medicare Advantage?
Medicare Part C, also known as Medicare Advantage, is a way to get your Original Medicare coverage through private Medicare-approved companies required to follow Medicare’s rules. These plans may include prescription drug coverage and as well as vision, hearing, dental, and/or coverage for fitness and wellness programs.
With Medicare Advantage, a limit is set on your out-of-pocket costs each year for covered services to offer you financial protection. Most Medicare Advantage plans also require you to use medical providers who are in-network. However, some plans do offer out-of-network coverage (which usually comes at a higher cost).
There are many different types of Medicare Advantage plans:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNPs)
- Medicare Medical Savings Account (MSA) Plans
The first two types of plans (HMO and PPO plans) are the most popular Medicare Advantage plans.
Should I Get Medicare Supplements or Medicare Advantage?
It’s important to keep in mind that Medicare Supplements act as an addition to your Original Medicare coverage, while Medicare Advantage is an alternative – a bundled way to get your Original Medicare coverage. You cannot get supplement plans when you have Medicare Advantage.
So, how do you choose? Should you get Medicare Advantage or a Medicare Supplement plan alongside your Original Medicare coverage? Here are a few items to consider to help you decide:
- Costs. On the Medicare Advantage side, check for the costs of a separate Part D plan if Part D isn’t included in your plan, premiums, copays, and any other out-of-pocket expenses. Make sure you also look at any limits in coverage. On the Medigap and Original Medicare side, calculate the cost of Part D, your premiums for Medicare and your Medigap policy, deductibles, copays, and coinsurance.
- Choice of doctors. Original Medicare lets you use any doctor or health care provider in the country that accepts Medicare, and most do. However, Medicare Advantage plans usually require you to use in-network providers (but unlike Original Medicare, they coordinate care, and your primary care doctor is kept in the loop about findings with specialists).
- Your health. Do you have a serious health condition that could bring you huge bills? A Medicare Advantage plan’s out-of-pocket maximum limit could be the protection you need. However, as discussed above, you’ll have more choices about where you receive care with Original Medicare plus a supplement. Check to see which option will save you the most money based on your medications and medical equipment.
- Your lifestyle. Do you travel or have dual residency? Do you have doctors you love and want to keep? Check to see if your providers participate in any Medicare Advantage plans or accept Original Medicare. Suppose you travel often or have dual residency. In that case, Original Medicare could be a better choice as it can be hard to find in-network providers in different areas of the country.
Broader benefits. Medicare Advantage plans often include coverage that Original Medicare doesn’t. Is vision, dental, or hearing coverage important to you? Are other Medicare Advantage benefits critical to have? Consider what broader benefits you may or may not need.
Coastal Insurance Planning can make it easy. As Medicare experts dedicated to helping you get the coverage you need to support yourself through retirement, we help you make complicated Medicare decisions based on your health and financial needs. Give us a call to get started today.