medicare advantage vs supplement plans

If Congress passes the Build Back Better Act before Christmas, Americans could have better access to medical care under Medicare. The bill includes a $35bn expansion to Medicare hearing services, plus a cost limit on insulin and other prescription drug costs. In its current form, Medicare offers a wide variety of healthcare plans for millions of Americans. But aside from Original Medicare, what is the difference between medicare advantage vs. supplement plans?

In this article, you will learn the essential differences between them so you can choose the best healthcare plan for you and your family.

Original Medicare: A Quick Run Down

Original Medicare covers Parts A and B. Part A is Hospital Insurance while Part B is Medical Insurance. Medicare Hospital Insurance covers the following:

  • Inpatient hospital stays
  • Skilled nursing facility services
  • Hospice care
  • Limited home health care services

Medicare Medical Insurance covers:

  • Some doctors’ services
  • Outpatient care
  • Various medical supplies
  • Preventive services

The federal government manages Original Medicare. It’s similar to other health insurance plans in that you pay a deductible before the plan begins. Then, once Medicare pays its share, you pay your continuing share through coinsurance or copayment. With Original Medicare, there is no yearly out-of-pocket limit.

Additionally, there is usually a monthly premium for Part B. 

Medicare Advantage vs. Supplement Plans

Looking above, you can see Original Medicare doesn’t cover many medical and healthcare services. For example, it doesn’t include routine vision and dental. Those who want prescription drug coverage need to join an additional plan. This is Plan D (Medicare Drug Plan). 

To gain more coverage, you have to buy other Medicare plans. There is where Medicare Advantage and supplemental plans come into play. These plans each provide different types of Medicare coverage. But, you cannot use both Medicare Advantage and supplement plans together.

Medicare Advantage Plan

Medicare Advantage (Medicare Part C) is an alternative to Original Medicare. Enrollment in a Medicare Advantage plan means you’re still in the Medicare program. But, you don’t receive benefits through the federally administered program.

Instead, you receive benefits from your Medicare Advantage plan. Insurance companies sell Medicare Advantage plans. The new plan replaces your Original Medicare coverage.

To be eligible for a Medicare Advantage plan, you must have Original Medicare. You must also live in the service area of the new plan you’re considering.

Many Medicare Advantage plans cover things like:

  • Routine vision
  • Routine dental
  • Health wellness
  • Prescription drugs

You will need to choose a Medicare Advantage plan with the same coverage level as your Original Medicare to add further services. This doesn’t apply to hospice care.

So, if you use these healthcare services, it is best to seek out insurance for them. If you don’t, whether through Medicare Advantage or not, you will be responsible for the costs out of pocket.

Even though you receive additional services with a Medicare Advantage plan, it doesn’t cover court of pocket expenses like deductibles and copays.

Additionally, Medicare Advantage plans use a provider network. Therefore, your costs are lower when you visit an in-network doctor or hospital. Conversely, going outside the network will result in higher prices.

Medicare Supplement Plan

Medicare Supplement Plans (Medigap) work with your Original Medicare coverage. They will cover costs that Original Medicare doesn’t. So, they are not stand-alone plans. Thus, you need to stay enrolled in Parts A and B to add a supplement plan. 

Medicare still primarily pays your healthcare bills. But some Medigap plans cover some cost-sharing expenses like coinsurance and deductibles. They also cover some out-of-pocket costs for Original Medicare.

Most states offer ten Medigap plans. Each plan letter standardizes coverage. This means you’ll get the same primary benefits from supplemental coverage within the same letter category regardless of which insurance company you get it from.

Further, Plan D, Medicare Prescription Drug Plan, is a supplement plan. Although, it’s separate from Medigap. Supplement insurance plans don’t usually offer extra benefits like Medicare Advantage. 

Supplement plans don’t use a provider network. So, you can choose any doctor or hospital that accepts Medicare.

What Is a Medicare Insurance Broker?

If you’re unsure which plan is for you, ask a Medicare insurance broker for tips. An insurance broker can assist with deciding between Medicare Advantage vs. supplement plans. A Medicare insurance broker is an insurance agent licensed to sell Medicare plans on behalf of insurance companies.

They are usually independent agents that work with multiple companies to provide clients with a more extensive range of options. An insurance agent will compare the plans so you can easily see what each one covers, costs and if it fits your needs.

The types of Medicare plans they sell depend on the states they’re licensed in. It also depends on the types of Medicare insurance they’re certified to sell. But, a Medicare insurance broker can guide you to make sure you choose the right health insurance policy. 

Medicare insurance agents get paid by commission. Whichever plan you choose, that insurance company will pay the agent. Thus, there is no extra fee for using a health insurance broker. Even better, you won’t have higher premiums from working with a licensed agent.

Working with an agent helps to see all your options. In addition, they can share insider information about rate trends, customer reviews, and demographics. Brokers can also help explain the details of each plan, so you’re not confused about what you’re buying.

Finally, a health insurance agent can help you with Medicare enrollment. Eligibility requirements for different plans can make registration difficult. Having the support is beneficial. Some agents will continue providing support after enrollment when you need to file a Medicare claim or resolve a billing issue.

Especially if you’re seeking to change your coverage during the Annual Enrollment Period, working with a broker is an excellent choice.

Find the Medicare Plan for You 

There is no winner between Medicare Advantage vs. supplement plans for further healthcare coverage. They both off unique services. What is best for you isn’t best for everyone, so having a variety is suitable for Americans.

Contact us at South Florida Medicare specialists to learn more about your health insurance options. Our healthcare experts are ready to offer you a free consultation. If you’re outside the South Florida area, search “medicare insurance broker near me” to get help with Medicare insurance.