There’s a lot of confusion surrounding the difference between Medicare Supplement and Medicare Advantage plans. While they may seem similar at first glance, they’re full of differences that can be vital for your specific healthcare needs.
While Original Medicare is a great foundation for comprehensive coverage it was never meant to cover everything! On Original Medicare alone there’s no Maximum-Out-of-Pocket limit, meaning there’s no cap on how high your bills can skyrocket. Original Medicare also doesn’t cover prescription drugs, most dental needs, or vision care. This is where the 2 very different ways to cover the gaps in Original Medicare come in.
Medicare Supplement plans were the 1st way of covering what Original Medicare doesn’t. Medicare Supplement plans are intended to begin where Original Medicare ends, and their benefits are built around what Parts A and B already cover.
Medicare Supplement benefits are set by the federal government and look the same across the different companies that sell them. There’s a small variety of different options ranging from Plans A-N. Don’t get these plans confused with Parts A and B of Medicare. They’re completely different! One of the most popular Medicare Supplement plans is Plan G which covers ALL medical and hospitalization costs after the Part A copay ($1408) and Part B deductible is paid ($203 in 2021). With Plan G you don’t have to worry about the 20% Part B coinsurance because Plan G covers it!
The main drawback that folks in the Clark County and Portland Metro areas may experience is difficulty in finding doctors and specialists who accept Medicare Supplement plans as many providers are beginning to gravitate towards Medicare Advantage plans.
However, this excellent coverage comes at a cost, and most people can plan on paying around $200 monthly for Plan G in addition to their Part B premium of $203. Medicare Supplement plans do not include prescription drug benefits, however. If you get a Medicare Supplement plan, you will also need to purchase a separate Prescription Drug Plan to cover your medications. Medicare Supplement plans do not cover dental or vision care, so you may find yourself shelling out extra cash for another standalone plan.
Medicare Advantage plans are a very different, more diverse way of covering what Original Medicare doesn’t cover. Unlike Medicare Supplement plans which have predetermined benefits set by the government, Medicare Advantage plan benefits are set by the private insurance companies that sell them. They have minimum standards set by the government that they must meet, but they are free to customize their plans with unique benefits and go above and beyond the minimum standards. Clark County and the Portland Metro are great areas to be a Medicare Advantage member! There’s around forty different Medicare Advantage plans to choose from, and the companies that sell them are in competition for your business, which leads to a great variety of plans to choose from.
Perhaps one of the biggest perks of Medicare Advantage is its cost and convenience. Medicare Advantage plans roll your Part A hospitalization coverage, Part B medical coverage, AND Part D Prescription Drug coverage into one plan and one low monthly premium. In fact, many plans start at $0 a month!
Medicare Advantage plans look a lot like the individual and family plans you may have had with your employer insurance. The plans have copays for different services, networks, and deductibles. Thankfully, you’ll find that these Medicare Advantage copays are much lower than your old plan! Because these plans are so diverse, you’ll want to talk with your Medicare agent about which plan is right for you.
Medicare Advantage plans also have lots of additional benefits as well! Perks like dental, vision, and hearing coverage, fitness programs like Silver Sneakers and Renew Active, and credits for Over-the-Counter medications are all member favorites. In fact, the extra Medicare Advantage perks are too numerous to list here, so be sure to look at our previous article “Bells and Whistles: The Often-Overlooked Benefits of a Medicare Advantage Plan” to get all the insider information.
Since these plans are networked, Medicare Advantage plans are generally better accepted by providers in Clark County and the Portland Metro and you can easily be referred to other in-network providers if needed. The majority of plans are either Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO). Both types have components that put the “advantage” into Medicare Advantage. Your agent can help you check to ensure your care team is in network before helping you pick a plan! You can also call the phone number on the back of your membership card to determine if a provider accepts your plan!
If Medicare is still feeling like rocket science, there’s always help available! An independent insurance broker like Stacey Johnson and her team of agents at Your Insurance Gal Agency can help you weigh all your options and explain how all this information applies directly to you. With their insider knowledge of local health systems and available Medicare options, they can make your Annual Enrollment Period effortless!