Medical Care Help Center.

Learn the Differences between Medicare Supplements and Medicare Advantage Plans

Insurance company health plans that have a contract with CMS (Center for Medicare and Medicaid) are known as Medicare Advantage Plans. Anyone with Medicare Part A and B is eligible to receive a Medicare Advantage plan. For people with certain health conditions, Medicare also offers specialized plans; but the general plans are not allowed to reject a person based on a health condition except for very specific reasons.

If an individual is enrolled in a Medicare Advantage plan, they will not lose their Medicare. If they want to end their Medicare Advantage plan then they can re-apply for original Medicare after a month has passed. Instead of using a Medicare card, they must use the insurance card that is provided by the Medicare Advantage plan while they are enrolled.

Having a Medicare Advantage plan may cost recipients nothing, or a small fee; although many require the Part B participation amount. Instead of having a portion of tax money go to original Medicare, the plans receive a payment from CMS every month. This tax money pays for a high percentage of the Medicare Advantage Plans.

By tradition, Medicare Advantage Plans were believed to be like HMO plans, where an insured person could only use certain doctors, hospitals, and other medical providers under the plan in order for expenses to be covered. Surprisingly, many Medicare Advantage Plans are actually HMO plans; however, PPO plans are also available with Medicare Advantage. Often, Fee for Service Medicare Advantage Plans are marketed aggressively because these plans will cover any medical providers that accept the insurance.

To figure out which plan works best for you, you must assess your own medical needs and preferences. If your current medical providers have a contract with a Medicare Advantage Plan’s HMO, then you may be very pleased with comprehensive coverage that has few extra payments. If you would like to have more choices, and doctors in your area will accept a Fee for Service plan, then an “Any Doctor” plan would be a good fit for you. Keep in mind that not all doctor’s offices will work with the Fee for Service plans, although many insurance companies claim that all offices accept the plan. With PPO plans, you can receive the greatest coverage at a low price inside your insurance network, and you will still be covered even if you use a different medical provider.

The Part D plan of Medicare (prescription drug coverage) is included in most, but not all, Medicare Advantage plans. Also, beyond their normal Part B premium, most Medicare Advantage plan recipients may have a minimal, or nonexistent, monthly premium. Some Advantage plans will even refund the Part B premium altogether. If you are an applicant in poor health, you must know that Medicare Advantage Plans are not permitted to do a lot of risk selection based on health condition, so one of these plans may be the best choice for you.

Medicare Supplement Plans

The traditional Medicare Supplement plans are very different from Medicare Advantage plans. With Medicare Supplements you are able to still use your original Medicare card, in addition to the health card provided by the Medicare Supplement plan. Also, these plans are provided through insurance companies, but the insurance companies only supplement the coverage “gaps” and deductibles that original Medicare Part A and B do not cover.

If you already have Medicare Part A and B, then by having a Medicare supplement plan you will be able to pay any portion of your medical bill that is not covered by Medicare. Obviously, each Medicare supplement plan will differ from one another so you need to understand exactly what a Medicare Supplement plan will cover before you sign up. For example, Medicare may pay 80% of your hospital bill and the supplement plan will cover the remaining 20%.Medicare supplements generally provide the widest access to health care.

Choosing a Medicare health plan can be one of the most important decisions anyone eligible for Medicare can make. Because this decision is so important, choose someone skilled to help you find the right plan to fit your needs, lifestyle, and budget.

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