Knowing the difference between Medicare Supplement and Medicare Advantage is not as hard as it seems. The main issue is that “Original Medicare” (Parts A and Part B) provides incomplete health coverage, leaving you exposed to many out-of-pocket expenses. There are two different solutions to this coverage problem: Medicare Supplement and Medicare Advantage. You can have one or the other, but not both. Here are the facts you should know about Medicare Supplement vs. Medicare Advantage, according to the official U.S. government website for Medicare.
What is Medigap?
The Medigap definition is easy: Medigap and Medicare Supplement are the same thing. In this article, we’ll use “Medicare Supplement” to keep things simple.
What is Medicare Part C?
Here is another easy one. Medicare Part C and Medicare Advantage are the same thing. This article will use “Medicare Advantage”. So far, so good.
What is Medicare Supplement?
Medicare Supplement is just that, a supplement to Medicare coverage. In order to use Medicare Supplement, you must have Original Medicare coverage (Medicare Parts A and B).
With Original Medicare, there are several expenses that are not covered—such as deductibles, coinsurance, and copayments. When you get Medicare Supplement from a private company, they pay for the gap in coverage between what Original Medicare pays for and what you owe (hence the name “Medigap”).
What is Medicare Advantage?
Medicare Advantage takes the place of Original Medicare.
Medicare Advantage plans are managed by private companies that supply health insurance according to strict Medicare rules. To keep costs down, your provider must be inside of a defined network. These savings are passed on to you in the form of low out-of-pocket expenses for in-network primary care visits and prescriptions.
What plan is more affordable?
Medicare Advantage plans will have lower out-of-pocket expenses because they manage the resources that you use. The cost of prescription drugs is usually included in the plan. Some plans offer other benefits too—such as vision, dental, and fitness programs. What you give up is the ability to see out-of-network providers at the same low cost.
With Medicare Supplement plans, you pay a premium to a private insurer to bridge your gaps in Original Medicare coverage. There are 10 standardized levels of Medicare Supplement, Plans A-N, each with their own level of coverage. However, the pricing and specific private insurers offering these plans will vary according to your region.
Additionally, with Medicare Supplement plans, the more gap coverage you want, the higher monthly premium you pay. Some expenses not typically covered by Medicare Supplement include vision, dental, and long-term care. If you want prescription drug coverage, you must join Medicare Part D.
What is an Enrollment Period?
If you just became eligible for Medicare, you can enroll in a Medicare Advantage plan right away.
Otherwise, you must wait until the open enrollment period, which is October 15th through December 7th of each year. During this time, you can enroll, drop, or change your Medicare Advantage plan. If you already have Medicare Advantage, from January 1st to March 31st, you can switch to a different Medicare Advantage plan or change back to Original Medicare.
Medicare Supplement open enrollment is much different because it doesn’t happen annually. Instead, the enrollment period lasts only for the first six months after you become eligible for Medicare.
During this open enrollment period, you cannot be penalized for having a pre-existing health condition. After open enrollment, insurance underwriters can charge you more if you have a pre-existing condition or deny you coverage altogether.
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Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.