SIMPLE TRUTHS: What’s the difference between Medicare Advantage plans and Medicare Supplement plans?

Posted on December 1, 2017

Medicare Advantage

Medicare Part C is more commonly referred to as Medicare Advantage. Medicare Advantage plans are health plans approved by Medicare and run by private companies like Health New England.

Medicare Advantage plans have to:

• Cover everything that Medicare Part A and Part B would of covered
• May cover services that Original Medicare wouldn’t cover:
  • Additional benefits such as vision, hearing, dental, or health and wellness programs
• May be offered with or without Part D

There are several types of Part C plans: HMO, HMO-POS, PPO, SNP, PFFS plans.

More about Medicare Advantage – Part C plans

• Similar to employer group plans
• Set network of providers
• Set monthly premium (must continue to pay Part B premium)
• Set copays/cost-sharing when you use services (pay as you go)
• Yearly out-of-pocket maximums
• Pharmacy coverage (Part D) is generally built into the plan
• May offer additional benefits beyond Original Medicare such as dental, fitness, weight watchers, vision, hearing, etc.
• May offer emergency coverage when traveling worldwide
• Ease of use
• Variety of plans to choose from
• Can change plans yearly during the Annual Enrollment Period

Medicare Supplement

Medigap insurance plans are also known as Medicare Supplement plans. In general, there are standardized plans (A-N) approved by Medicare. Each state chooses how many plans it will offer. Massachusetts does not follow the standard A-N Medicare Supplement Plans.

• There are two Medicare Supplement Plans offered in Massachusetts:
  • Medicare Supplement Core
  • Medicare Supplement 1
• All Massachusetts Medicare Supplement plans cover the same set of core benefits
• The differences between the two Medicare Supplement plans are:
  • Premium cost
  • Premium discount when newly eligible
  • Additional benefits: like fitness coverage, foreign travel

More about Medicare Supplement – Medigap plans

• You are covered nationwide (US and US territories) and will be accepted by any Medicare approved facility or health care provider
• Not covered outside of US or US territories
• Only cover what Original Medicare covers
• Fills in the gaps to Original Medicare
• May be responsible for Part A and Part B deductibles and coinsurance – depending on which Medicare Supplement plan you choose
• Does not include Part D drug coverage – must purchase separately
• May not include additional benefits such as dental, hearing, vision, fitness, etc.
• Guaranteed renewable as long as you pay your premium
• Can switch Medicare Supplement plans anytime during the year

Learn about Health New England plan options at healthnewengland.org/medicare.

Categories: Medicare Simple Truths, MemberMatters - Medicare, Simple Truths

Tags: Medicare Advantage, Medicare Supplement