Medicare 101: Medicare Supplement Plans and Medicare Advantage Plans

By Deirdre R. Wheatley-Liss, LL.M, CELA

Medicare Supplement Plans or Medigap Insurance are designed to cover care that is not covered by Medicare Parts A and B – co-pays and deductibles, vision care, hearing aids, fitness programs and other benefits. When you have a Medicare Supplement Plan or Medigap Insurance, Medicare Parts A and B are your primary insurance and the Supplement Plan pays some or all of the expenses that Parts A and B do not pay.

What kind of Supplement Plans are available? The Supplement Plans available to you really depends on where you live and what is offered by the insurance companies serving your area. You should contact insurance carriers serving your state to see what they offer. Your needs and the coverage offered changes year to year so you should plan to re-evaluate your Medi-gap Insurance each year during the open enrollment period (October – December annually).

Medicare Advantage Plans, as I discussed in a previous post (Medicare 101: What Medicare is and Who is Eligible), are designed to roll Medicare Parts A and B together into a managed care plan, usually including a prescription drug benefit.

Advantages and Disadvantages of Supplement and Advantage Plans. Whether you decide to buy a Supplement Plan or Medicare Advantage Plan will probably hinge mostly on the cost. Medicare Advantage Plans are significantly less expensive than Medicare Supplement Plans. But Advantage Plans are more limiting in terms of benefits, also.

With a Medicare Supplement Plan or Medigap Insurance, one of the big advantages is that you can see any doctor that takes Medicare anywhere in the United States. That's not every doctor, but it's the majority of doctors and so, that's a big plus. Also, no referrals are necessary when you're working with a Medicare Supplement Plan. You choose which doctor or specialist to go to and when.

But when you buy a Supplement Plan Medigap Insurance, it will generally have a higher premium than a Medicare Advantage Plan. Also, generally speaking, a Medicare Supplement Plan Medigap Insurance will not have a co-pay or deductible where Medicare Advantage Plans typically do.

Can you get a Medicare Supplement Plan or Medigap Insurance that covers medical care outside the United States?

Yes, if you are enrolled in Medicare and want medical coverage for care administered outside the United States. Many such Supplement Plans have a lifetime coverage limit which is generally 80% of the first $50,000 of care outside the U.S. It may be possible to get coverage beyond that. You should contact insurance carriers in your area for specifics.

This post is for general informational purposes only. The specifics of your situation could affect your eligibility for Medicare and the specific benefits you receive. For a video presentation of this information, please visit Medicare 101: Maximizing Your or Your Loved One’s Health Care in Retirement. For more detailed information, please visit www.porzioplanning.com or contact us for a free 20 minute telephone consultation.