Medicare Advantage Vs Medicare Supplement Plans
If you are enrolling in Medicare or are looking to change plans, you may wonder which plan is best for you. When deciding which plan to enroll in, you must first choose between a Medicare Advantage plan and a Medicare Supplement plan.
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There are many differences between Medicare Advantage vs. Medicare Supplement plans. So, it is crucial to do your research and thoroughly understand how each plan type works before deciding. You are not alone in your research, and we are here to help.
You Cant Enroll In Both Medigap And Medicare Advantage
You cant join a Medigap plan if youre already enrolled in Medicare Advantage. If you enroll in a Medicare Advantage plan, you cant use a Medigap policy to cover your out-of-pocket health care expenses.
Medigap can be only be purchased by people enrolled in Original Medicare. If you have Medicare Advantage and want to join a Medigap plan, you have to switch to Original Medicare before you can buy a Medigap policy. Contact your Medicare Advantage Plan carrier to see if you can disenroll.
If you already have a Medigap policy and want to join a Medicare Advantage Plan, you must drop your Medigap policy.
Which Is Better: Medicare Advantage Vs Medicare Supplement
Medicare does not offer a one-size-fits-all plan. So, the best policy for you is the policy that best meets your healthcare needs.
Medicare Supplement plans are the best option if you want complete reassurance and predictability with your healthcare but are comfortable paying higher premiums in exchange for lower out-of-pocket costs. Whereas Medicare Advantage plans are the best option if you are hoping to save on monthly premiums and receive additional benefits while accepting responsibility for additional out-of-pocket costs at the doctors office.
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For overall ease and reliability, our recommendation is always Medicare Supplement plans. However, we know that may not work for everyone. Our goal is to provide you with your best options regardless of plan type.
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Selecting A Medigap Plan: Recent Changes Limit Choices
Medigap policies are private plans, available from insurance companies or through brokers, but not on medicare.gov. They are labeled Plans A, B, C, D, F, G, K, L, M, and N, each with a different standardized coverage set. Plans F and G also offer high-deductible versions in some states. Some plans include emergency medical benefits during foreign travel. Since coverage is standard, there are no ratings of Medigap policies. Consumers can confidently compare insurers prices for each letter plan and simply choose the better deal.
As of Jan. 1, 2020, Medigap plans sold to new Medicare beneficiaries aren’t allowed to cover the Part B deductible.
Before 2020, most people who bought Medigap policies chose Plan F, which gave the most comprehensive coverage, including paying for the Medicare Part B deductible . However, in an effort to trim Medicare expenses, Congress suspended Plans C, F, and High Deductible F for people who become Medicare-eligible in 2020 and beyond.
Plan D and Plan G have similar benefits to Plan C and Plan F, except for not covering the Part B deductible. People who signed up or became eligible for Medicare before 2020 can purchase or continue Plans C or F, though prices may rise and it may be a better deal to switch to a plan that doesnt cover the deductible.
Can You Switch Between Original Medicare And Medicare Advantage
As a final note, no matter which option you decide is right for you, you can switch from Original Medicare to Medicare Advantage or vice versa. The two main times you can switch are the Medicare Annual Enrollment Period and the Medicare Special Enrollment Period for qualifying life events, if you qualify.
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High Medicare Star Ratings: Blue Cross Blue Shield
Highest average Medicare star rating of a national insurer
Most plans offer additional drug coverage in the gap
Highmark, a BCBS company, ranked highly for customer satisfaction
Excellent value for FL and TX plan members
Not available in all states
No Medicare Advantage PFFS plans
Blue Cross Blue Shieldâs average Medicare star rating for MA plans with drug coverage is 4.27, well above the industry average of 3.97. This means that, according to the Centers for Medicare and Medicaid Services , BCBS members have a better-than-average experience compared to members of other plans. In fact, BCBS MA plans with drug coverage are the highest-rated nationwide, except for Kaiser Permanente which only offers coverage in eight states.
BCBS also offers excellent value for members in Florida and Texas, based on a review of plans with the lowest out-of-pocket maximums in those states.
The companyâs vast network includes names like Anthem Blue Cross Blue Shield and Highmark. Highmark has a more limited coverage area , but was ranked third by J.D. Power for customer satisfaction.
Medicare Vs Medicare Advantage: Which Should I Choose
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When its time to sign up for Medicare, one of the first and most substantial decisions you face is whether to choose Original Medicare or Medicare Advantage. In 2022, 45% of Medicare beneficiaries have a Medicare Advantage plan, according to data from The Chartis Group. The decision will depend on several factors, including where you live, your current and potential health care needs and your financial situation.
Both options provide coverage for your major medical needs. But your out-of-pocket costs and choices for doctors and hospitals will depend on the program you choose.
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How And When To Shop For A Medigap Policy
You can buy a Medigap policy anytime you have Medicare Parts A and B. This insurance doesnt have an open-enrollment period during certain times of year, like Medicare Advantage and Part D plans.
But insurers can reject you or charge more if you have preexisting conditions unless you buy a policy during certain times, such as within six months of enrolling in Medicare Part B if youre 65 or older. Medigap insurers must also offer you a policy regardless of preexisting conditions in other situations, such as if you had been enrolled in a Medicare Advantage plan and you move outside of the plans service area.
If you qualify for Medicare before age 65 because of a disability, federal Medigap rules dont protect you from being rejected or charged more because of your health. But some states have extra protections for people who are younger or older than 65 who might find it difficult to get the lowest prices. Contact your State Health Insurance Assistance Program to find out more about the rules in your area.
Choosing A Medicare Advantage Plan
Medicare Advantage Health Plans are similar to private health insurance. Most services, such as office visits, lab work, surgery, and many others, are covered after a small co-pay. Plans might offer an HMO or PPO network and all plans place a yearly limit on total out-of-pocket expenses. Each plan has different benefits and rules. Most provide prescription drug coverage. Some require a referral to see a specialist while others do not. Some may pay a portion of out-of-network care, while others will cover only doctors and facilities that are in the HMO or PPO network. There are also other types of Medicare Advantage plans.
Selecting a plan with a low or no annual premium can be important. But it’s also essential to check on copay and coinsurance costs, especially for expensive hospital stays and procedures, to estimate your possible annual expenses. Since care is often limited to in-network physicians and hospitals, the quality and size of a particular plans network should be an important factor in your choice.
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Can You Have A Medicare Advantage Plan And A Medicare Supplement Plan
Medicare Advantage and Medicare Supplement are different types of Medicare coverage. You cannot have both at the same time. Medicare Advantage bundles Part A and B often with Part D and other types of coverage. Medicare Supplement is additional coverage you can buy if you have Original Medicare Part A and B.
Learn more about Medicare Supplement
Can I Drop My Medicare Advantage Plan And Go Back To Original Medicare
Yes, but you must do it during one of the open enrollment periods. You can switch back to Original Medicare during the annual Medicare Open Enrollment period from October 15 to December 7. Your new coverage will go into effect January 1. Or, you can switch during Medicare Advantage Open Enrollment from January 1 to March 31. Your new coverage will go into effect on the first day of the month after you ask to join the plan.
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Aarp Medicare Plans: Medicarecomplete Or An Aarp Medicare Supplement
The word is out. It just doesnt make sense to enroll in Medicare and not seek additional coverage. Whether you choose a Medicare Advantage Plan or go with a stand alone Part D Drug Plan and a Medicare Supplement, AARP Medicare Plans are worth taking a look at.
Original Medicare entails too much financial responsibility for most people. Medicare was never intended to provide 100% protection from financial exposure due to health related claims, but rather a safety net.
Medicare Part A offers protection from hospital stays, but your share of the cost is high.
- 2013 Part A hospital deductible is $1184 .
- 61st through 90th day requires a $296 per day co-pay.
- 91st day and after $592 per day co-pay.
- Once lifetime reserve days are used, Medicare pays nothing.
Your responsibility for out-patient charges is also steep. Medicare covers 80% of allowable charges and you are responsible for 20% of the charges. Keep in mind that most medical procedures today are performed on an out-patient basis.
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What Are Medicare Advantage Plans
Private insurance companies offer and administer Medicare Advantage plans. These plans take on the role of primary coverage for Medicare beneficiaries. Medicare pays these private insurance companies to take on your risk.
These plans can also come with a regional network of doctors and hospitals, meaning coverage from the plan will not travel with you. Additionally, your current doctor may not accept the plan as coverage.
Medicare Advantage plans must offer the same benefits you get from Original Medicare and can also include additional benefits. However, these additional benefits vary from plan to plan. When you enroll in a Medicare Advantage plan, you agree to pay higher out-of-pocket costs in the form of cost-sharing in exchange for a lower monthly premium.
Often, Medicare Advantage plans include prescription drug coverage. While not all plans offer drug coverage, the majority of Medicare Advantage HMO and PPO plans include this additional benefit.
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Medicare Advantage Plan Benefits
Private insurance companies have a bit more flexibility in designing Medicare Advantage plans, so youâll find more differences between plans. This means you need to be more careful comparing plan options to make sure you donât overlook anything.
As mentioned, Medicare Advantage plans give you the opportunity to get coverage for benefits beyond Original Medicare. This may include routine vision and dental, hearing, and health wellness programs. Normally, under Original Medicare, youâd pay for these services out of pocket unless you have other insurance.
Another benefit of Medicare Part C is that many of these plans also include Medicare Part D prescription drug coverage as part of the plan coverage. Also known as Medicare Advantage Prescription Drug plans, these plans give you the convenience of having all of your Medicare benefits administered through a single plan.
If you enroll in a Medicare Advantage Prescription Drug plan, you will not need to enroll in an additional Medicare Prescription Drug Plan. In fact, if you are enrolled in a Medicare Advantage plan that includes prescription coverage and also enroll in a stand-alone Medicare Prescription Drug Plan, you could be automatically disenrolled from your Medicare Advantage plan.
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You Can’t Have Both So You Must Choose Wisely
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Anyone who’s ready to sign up for Medicare has a lot of decisions to make. But one decision is especially importantshould you choose Medicare Advantage or use Medigap to supplement your Original Medicare plan?
Do You Want The Simplicity Of One Plan To Meet Your Health Care Needs A Medicare Advantage Plan May Be The Answer
Medicare Advantage plans combine Medicare Part A and Part B also known as Original Medicarein a single plan. Most plans include prescription drug coverage. Many plans offer additional benefits and features like routine vision, hearing, dental and fitness coverage not provided by Original Medicare.
With UnitedHealthcare® Medicare Advantage plans you get more care for less, more of the extras you need, and more peace-of-mind.1 Want more for your Medicare dollar? You’ll get it from America’s largest Medicare Advantage plan provider.2
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What Is Medicare Part C
A Medicare Advantage Plan is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called Part C or MA Plans, are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A and Part B coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage .
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services . These rules can change each year.
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Nearly All Medicare Advantage Enrollees Are In Plans That Require Prior Authorization For Some Services
Medicare Advantage plans can require enrollees to receive prior authorization before a service will be covered, and nearly all Medicare Advantage enrollees are in plans that require prior authorization for some services in 2022. Prior authorization is most often required for relatively expensive services, such as Part B drugs , skilled nursing facility stays , and inpatient hospital stays , and is rarely required for preventive services . Prior authorization is also required for the majority of enrollees for some extra benefits , including comprehensive dental services, hearing and eye exams, and transportation. The number of enrollees in plans that require prior authorization for one or more services stayed the same from 2021 to 2022. In contrast to Medicare Advantage plans, traditional Medicare does not generally require prior authorization for services and does not require step therapy for Part B drugs.