Medicare

Posted: September 16, 2022

Health & Wellness

What Is the Difference Between Medicare With Supplement and Medicare Advantage?

Medicare is the federal health insurance program for people who are aged 65 or older, as well as certain younger people with disabilities or with end-stage renal disease (ESRD). Although enrollment in Original Medicare generally coincides with dates three months following a person’s 65th birthday, there is another enrollment period known as Fall Open Enrollment. This is the time to make any changes you might wish to make to your Medicare plan, including Medicare With Supplement and Medicare Advantage.

Fall Open Enrollment occurs each year from October 15 through December 7. Any change you make during this period in 2022 will take effect on January 1, 2023.

What Is Included With Original Medicare?

Medicare’s benefits, known as Original Medicare, consist of the following types of coverage:  

  • Medicare Part A (Hospital Insurance), which covers hospital services (e.g., inpatient hospitalizations, surgeries and similar care) 
  • Medicare Part B (Medical Insurance), which covers preventive services, labs, x-rays, vaccinations, and other outpatient costs 

Other options are also available for Medicare recipients.

What Is Medicare With Supplement?

A Medigap policy is an insurance policy that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medigap policies are sold by private companies, and can help pay for some of the costs that Original Medicare doesn’t, like copayments, coinsurance, and deductibles.

Cost is usually the only difference between Medigap policies with the same plan letter sold by different insurance companies.

medicare supplement insurance plans chart

The most popular of the Alphabet Plans are F & G. They can help cover the excess charges that Original Medicare does not, such as out-of-pocket hospital and doctor’s office care costs.

It’s important to note that as of December 31, 2019, Plan F is no longer an option for new Medicare enrollees. But if you enrolled in Medicare before 2019 or if already have Plan F, you can still make a decision between Medicare Plan F and Plan G.

What Do Medicare Plan F and Plan G Cover?

Medicare Plan F and Plan G are similar and offer the same basic coverage benefits, including no networks, limited referrals, and the following:

  • Part A coinsurance and hospital costs
  • Part B coinsurance or copayment
  • Part A deductible
  • Part B excess charges
  • Blood (first 3 pints)
  • Part A hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Up to 80 percent of medical emergency costs while traveling in another country
  • Limited referrals

Plan F and Plan G do not include coverage for gym memberships or dental, vision, or hearing.

How Do Medicare Plan F and Plan G Differ? 

Although the plans have similarities, there is one key difference between Plan F and Plan G: With Medicare Plan F, you get the most coverage available. In addition to the coverage mentioned above, Plan F also covers Medicare Part B deductible payments. Plan G does not.

Because there is more coverage, you may pay higher premiums for Plan F, although high-deductible options are available to help keep premiums lower. If you’re currently enrolled in the Plan F high-deductible option for 2022, you must pay for Medicare-covered costs up to the deductible amount of $2,490 before your Medigap plan kicks in to cover any expenses.

Each year, the Center for Medicare and Medicaid Services (CMS) issues a guidebook for Medicare and Medicaid beneficiaries called Medicare & You.  The handbook, which is made available to all current and soon to be Medicare beneficiaries, is published in the fall and mailed (September) for the upcoming year.    You can also go to Medicare.gov to download a copy.

What Is Medicare Advantage Plan C?

A Medicare Advantage Plan (like an HMO or PPO) is another health plan choice you may have as part of Medicare. These plans, sometimes called Part C or MA Plans, are offered by private companies that have been approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage. Medicare Advantage Plans may also offer additional coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a specific amount for your care every month to the companies that offer Medicare Advantage Plans. These companies must follow the rules put in place by Medicare.

It’s important to note that each Medicare Advantage Plan can outline different out-of-pocket costs and have different rules for how you get services. This includes restrictions on whether you need a referral to see a specialist or if you must see only doctors, facilities, or suppliers that belong to the plan for nonemergency or nonurgent care. These rules are not hard and fast, so they are subject to change from year to year.

What Does It Cover?

With a Medicare Advantage Plan, you may have coverage above and beyond what Original Medicare covers, such as gym memberships or discounts, and some vision, hearing, and dental services (such as routine check-ups or cleanings). Some plans offer even more benefits. For example, some plans may offer coverage for services such as transportation to doctor visits, over-the-counter medications, and services that promote your health and wellness.

Other key points to highlight with a Medicare Advantage Plan include:

  • Participants must stay in network with their HMO or PPO, or they could be responsible for higher costs.
  • Participants need referrals for specialists.
  • The Advantage Plan includes limited dental, vision, and hearing.
  • Gym membership is included.

Some plans offer tailored benefit packages for enrollees who suffer from some chronic illnesses. These packages will provide customized benefits to treat specific conditions. Check with the plan to learn more about benefits, qualifications, and limitations.  

How Can I Find Out More? 

There are some glaring contrasts between Medicare with a supplement and Medicare Advantage plans, so it’s essential to do your research. If you don’t fully understand the plan that you are on or looking to join, you may find yourself with coverage that doesn’t pay for the healthcare you need. Before signing up for a plan, you should reach out to a professional and get all the facts about that plan. You can also reach out to Medicare directly.

Download a helpful resource comparing Medicare With Supplement and Medicare Advantage plans.

 

About the Author

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Jordan Curtis, Licensed Insurance Agent

I am an insurance broker for American Senior Benefits. We assist members of the Senior community with retirement related issues. I mainly specialize in Medicare but can also help Seniors with long/short term care, life insurance, and Annuities. My main focus with Medicare is making the frustratingly complicated stuff easier to understand. I have been helping seniors do this for 5 years now. I take immense pride in what I do. I look forward to helping you with your needs.

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