Medical Care Help Center.

Medicare Supplement Plans – Should You Choose Them Over Medicare Advantage Plans?

There are two choices available to individuals seeking Medicare coverage as well as the federal health care program. They are known as Medicare Supplement plans and Medicare Advantage plans. Although these plans are somewhat similar, overall, their benefits differ greatly. You must individually consider each plan and determine which has the best options in your situation. In most instances, when you qualify medically and can afford a supplement, or Medigap plan, it is to your advantage to purchase the plan.

The best rule to follow when trying to understand the differences is to remember that Advantage plans pay as a replacement for Medicare coverage, while Supplement plans pay after Medicare coverage. Advantage plans are known as the privatized form of the federal Medicare program, and they replace it altogether. However, you must still be enrolled in the government program, but they do not pay you benefits. Conversely, Supplement plans are available to fill in the “gaps” of coverage that are not paid by the government’s program because they are designed to supplement.

There are several reasons why Supplement plans are generally more useful than the Advantage plans. Here are a few good reasons:

  • You can use supplements at any doctor that accepts the federal Medicare program; however, most Advantage plans require that you stay in the network of doctors/hospitals that they are affiliated with. Also, these networks are not fully developed in some areas, so some people may have to drive a ridiculous distance just too see a doctor or go to a hospital in their network. This situation can be very irritating.
  • Medicare supplements generally do not make use of cost-sharing, or deductibles and co-pays. Most supplement plans cover 20% of costs not provided through the federal program, in addition to one (or both) of the deductibles. On the other hand, Advantage plans make use of cost-sharing with deductibles and co-pays as a component in their plans. A great number of the Advantage plans require a co-pay of $15-$40 when you visit the doctor’s office. Also, there is a daily co-pay for hospital stays for the first 5-10 days, plus deductibles and/or co-pays for hospital admission.
  • Medicare supplements will not annually modify coverage because they have not changed and they have been federally standardized since 1992. However, Advantage plans are always modified each year, and in recent years, every change has been against the favor of the insured person.

For those over 65, the two insurance choices are Supplements and Advantage plans and there are specific benefits offered in each plan. However, if you are medically qualified and can afford a supplement plan, it is in your favor to choose the supplement for comprehensive insurance coverage for those over 65. Make sure to examine each plan and recognize what coverage you will need in your current situation before you finalize your decision. Insurance coverage is a necessity, so why not make the best choice for your health coverage?

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