Medicare Advantage vs Medicare Supplement Plans – couldn’t be more different
The only thing better than having choices is understanding exactly what you are choosing between. Deciding between Medicare Advantage vs Medicare Supplement Plans is the first step to getting your best plan.
If you are about to be Medicare eligible or are contemplating changing your Medicare coverage, it’s important to understand the differences between Medicare Advantage and Medicare supplements (also known as Medigap).
If you are new to Medicare and unsure of the differences you are not alone. Even people who have been enrolled in Medicare for some time do not always understand the differences.
Check out my Free 8 Part Video Mini-Course to help sort things out. Making the wrong decision on your Medicare coverage could cost you in more ways than one.
Understanding the differences – Medicare Advantage vs Medicare Supplement Plans
Even though the title of this article should make it clear that Medicare Advantage Plans and Medicare supplements are two separate types of coverage, many people use the terms interchangeably and believe that Advantage plans are actually Medicare supplements. This is not the case.
Medicare supplement plans have been around as long as Medicare. The government refers to Medicare supplements as Medigap. The term Medigap is a reference to the plan filling the gaps left by Medicare. Plans are standardized and will include the same coverage no matter which company is offering the plan. AARP Medicare Supplement Plan N, will be identical to any other company’s Plan N. Rates will vary from one company to the next.
It is important to note that Medicare supplement plans will only fill the gaps for covered expenses. Your Medicare supplement will not pay anything toward non-covered expenses such as dental, vision or hearing.
When you have a Medicare supplement plan, you will pay your Medicare Part B premium and a premium to the the insurance company for the Medicare supplement. Supplement plans do not include Part D drug coverage, so you will need to enroll in a separate Part D drug plan. Medicare supplement plans do not require that you use a network, but rather choose any provider that accepts Medicare assignment.
Compare both Medicare supplement and Medicare Advantage plans by visiting ehealthInsurance. You can also call them toll free to speak with a licensed agent.
Medicare Advantage plans are not Medicare supplement plans, but rather another way to receive your Medicare benefits. With an Advantage plan, a private insurance company contracts with CMS (Centers for Medicare and Medicaid) to administer your Medicare. The thought behind this is that a private insurance company is more cost efficient than the federal government and you should be able to receive some additional benefits. Medicare Advantage plans are annual plans and you are subject to enrollment periods.
Unlike Medicare supplements, Advantage Plans are not standardized plans. Humana Medicare Advantage plans and AARP Medicare Advantage plans, for example, will not offer identical coverage. Plan premiums can vary and may be as low as $0. Advantage plans do have cost sharing features, such as, co-pays, coinsurance and deductibles.
Many Medicare Advantage plans are network based plans, so you may need to check out the plans network to insure that you’re happy with the providers. Most Medicare Advantage plans include Part D drug coverage and many added benefits not offered by traditional Medicare. Extras include; dental, vision, hearing, gym memberships, discounts on medical supplies and in some cases transportation to and from medical appointments. Benefits vary from plan to plan.
Medicare Advantage vs Medicare Supplement Plans – finding resources
Once you have decided on either a Medicare Advantage plan or a Medicare supplement plan, it’s time to do your homework to get the best plan.
Shopping online is probably the easiest way to cover a lot of ground. Meeting with several agents can be time consuming. Also a good resource for an overview is the Medicare website. You can review Medicare Advantage vs Medicare Supplement Plans.
You can request quotes online or be mailed written brochures to review in your home. Once you understand the differences between Medicare Advantage and Medicare supplement plans you’ll have the hard work behind you.
What I found, when I was turning 65 and making the decisions involved with Medicare… was that none of the doctors that I called accepted anything but advantage and only 2 of those. Off the record information seemed to indicate that the government did not pay promptly and advantage covered that. I am not well versed, or all that intelligent, this is just what my experience was.
I went with one of the two accepted advantage plans… with little out of pocket expense. Now I face some real health challenges and find my advantage plan for 2011, is offering much less help.
Autum, I’m sorry to hear about your health problems. Medicare Advantage plans change on an annual basis. Some plans may not renew, while others may enter a market. Don’t merely accept the renewal of your current plan without exploring your options. Also, many insurance companies are making Medicare Supplement Plan N available with little or no underwriting. This may also be something to explore.
Turning 65 next month and receiving piles of insurance companies mailing regarding supplemental plans. Naturally, very confusing. Had a friend who works for AFLAC come and sit down with me to help me understand. She of course wants to sell my their products but wanting to do more research of what other companies have to offer. My question…I currently have Kaiser (retired from a company in which I have had coverage since day one form Kaiser). Knowing Kaiser picks up percentage, how does this work with Medicare + supplemental plans? Do I really need to keep paying for a Kaiser coverage?
Gael, You ask some good questions. You’re ahead of the game by questioning whether your former employer’s policy is by default, the best. Many people assume that keeping their group policy after they retire will give them the best coverage at the lowest cost. This is not always the case. Often this type of policy will require deductibles, co-payments, coinsurance and require you to utilize network providers. Frequently the premium will be as high or higher than a traditional Medigap policy, where depending on the plan, you may have little or no out-of-pocket costs.
Medigap policies are standardized plans and coverage will be the same from one provider to the next. Medicare supplement Plan F is the most comprehensive and Medicare supplement Plan N is a good alternative to keep your premium lower if you don’t mind a small amount out-of-pocket. With a supplement you will need to continue to pay your Medicare Part B premium and also purchase a stand-alone Part D plan.
To compare, look at Kaiser’s premium and any potential out-of-pocket expenses. Also check the network restrictions. Then look at standardized Medigap policies and add the cost of a Part D plan. Recognize that you may have very little or no out-of-pocket expenses and can use any provider that accepts Medicare.
My husband will be turning 65 in March. We are looking into purchasing some type of supplement to his Medicare. We have had someone come and talk to us about Advantage plan. Not sure if we should go with Advantage plan or go with Supplement. He is currently covered on my insurance through my employer and will be covered until June. He is currently in good health condition, but never know what the future could bring for either of us. What should be our biggest determinants about our choice.
Paul, For most people the biggest determinant related to which type of Medicare plan to choose is money. If affordable a Medigap policy will afford you the most predictable coverage and product stability without the network restrictions. The biggest reason someone would endure the constant changes to Medicare Advantage Plans and have less freedom of choice is because they cannot afford a Medigap policy or don’t completely understand the cost sharing structure of Advantage plans. Unfortunately, some Medicare Advantage plans are as expensive or more expensive than many Medigap policies for someone aging into Medicare. Check out Medicare Supplement Plan N to see why many people are choosing it over a Medicare Advantage plan.
If I chose a Medicare Advantage plan, at a latter date will I be able to get back into the government Medicare plan?
Johnny, If you enroll in a Medicare Advantage plan you can either keep the plan for the full calendar year and choose not to renew the plan or dis-enroll during the dis-enrollment period (Jan. 1 through Feb. 14). In either case you will return to original Medicare.
I am 63 years old and on disability, I have had Mutual of Omaha supplement I am very pleased with it especially last year I was in the hospital 2 times and spent 6 weeks in rehab and did not receive a bill for any of it. The only thing is the expense over 200.00 for the insurance plus the cost of medicare and Part D. I feel I probably would be better to stick with the supplement instead of an Advantage plan but I would like to make sure. Any help would be appreciated.Thanks
Lea, As long as the supplement is not causing a financial hardship it sounds as though you have answered your own question. As we age the likelihood that we will need to use our insurance increases. If it’s affordable, there is no hurry to make a change. Even if the premium is a little pricey, at least you know what to budget for.
Can you explain or direct me to documentation of what types of insurances can AND which cannot be secondary or supplemental to the Medicare Advantage Plans? We were given the impression that Medicare Advantage Plans could not have supplemental insurances.
Rhonda, You cannot be enrolled in a Medicare Advantage plan and have supplemental coverage. Learn more by visiting medicare.gov or reviewing the Medicare and You Handbook.
plan N looks good but what about the excess charges part. is there alot of doctors who charge this. I’m ok with the deductible for part B. I think I will go with plan F or N.should I go with united healthcare ot mutual of omaha? Big difference in price. Is there really excess charges?
Woody, If you stick with providers who accept Medicare assignment you should be fine. Ask your providers. Plans are standardized, so when choosing a plan, unless you have some aversion to a specific company, why not choose the lower premium? just keep in mind that premiums will probably increase each year.
I, too, am trying to compare the “pros” and “cons” of “Advantage” vs. “Supplemental” plans.
An insurance agent told me that a medical provider MUST – by law – accept “Supplemental” policy coverage. Is that true?
Steve, I have never heard that it was illegal not to accept private insurance. Sounds like something an insurance agent who was looking for a commission would say. Ask him to give you a credible reference that supports his claim. That said, if a provider accepts Medicare they will normally accept a Medicare supplement. Plans are standardized and they have virtually no surprises from the insurance company.
JUST SO CONFUSING… BEEN WITH AARP SINCE 1999..MAYBE I SHOULD CHECK OUT ADVANTAGE
Dorothy, It wouldn’t hurt to check out all your options. Speaking with a local agent may benefit you.
David, my husband will be 65 in Nov. We just retired to Ark. from TX and still have Drs. in TX we want to continue seeing. Based on that info. would a supplement be better over an Advantage plan? Also, what happens on an Advantage plan if your health declines? Can you be cancelled or denied coverage at renewal or uprated because of your health?
D. McCord, A supplement will allow you to use any provider that accepts Medicare nationwide and would not cause any problems with you seeing providers out-of-State. An Advantage plan is usually network-based and you may be limited going out of State depending on the type of plan. With an Advantage plan you cannot be cancelled or rated up due to your health. The only stipulation related to your health is that you do not have end stage renal disease when you enroll. You can also change Advantage plans each year.
If a supplement is affordable, you may not want to waste the Medigap open enrollment period. If rates get too high as time goes by you can always drop the supplement and enroll in an Advantage plan.
ATT: Dorothy Primavera- My parents always had a supplemental with United Healthcare with AARP. This year they signed up for the AARP Advantage with United Healthcare called “Medicare complete”. Mom has had alot of PT/OT bills coming in that are NOT paid for. ALSO, UNITED HEALTH CARE DIDN’T TELL THEM THAT PAYING FOR A SUPPLEMENTAL IS NOT NECESSARY AND CAN’T BE USED WITH THE “ADVANTAGE” PROGRAM!!! After I figured it out, they gave them a refund…BUT I WONDER HOW MANY OTHER ELDERLY PEOPLE ARE GETTING RIPPED OFF BECAUSE THEY DON’T KNOW THIS!
What is excess cost and is the deductable always 20%
N-Plan. I would like to kmow the risk of Plan N compared
to Plan F
Jerry, Doctors can charge up to 15% beyond what Medicare will pay. This is the excess cost. The deductible is the Part B deductible, currently $147. Doctor’s visits could be up to $20 not 20%.
UHC Advantage Complete premium is $2,600 a year cheaper
than UHC plan N. (Husband & wife)
We can afford the N plan but is it worth the xtra premium
What do you think?
Gail, Value is in the eye of the beholder. How much would you spend in copays and coinsurance if you enrolled in the Advantage Plan? If the two of you require some services, you will probably have more costs out-of-pocket with the Advantage plan. The Advantage plan will require you to use a network and Plan N will not. How much is your freedom to choose any provider worth? These are some things you will need to consider. If I could afford the premiums… I would buy the supplement… but that’s not necessarily the right choice for everyone.
I had a medicare supplement plan F ( high deductible) last year but I switched to a medicare advantage plan this year.
Am I better off with a medigap plan or advantage? I’ve been trying to see the differences on line but they are vague. Example, what about a hospital stay and surgery? Which plan would provide the most coverage and pay the best benefit? Does having an advantage plan actually cost me more money if I need services?
Tom, Answering your first question is difficult because Medicare Advantage Plans are not standardized, so it’s not easy to make a comparison. If you want a plan that gives you the most comprehensive coverage buy Plan F without the high deductible option. If that’s not affordable, keep in mind that all Medicare advantage Plans have a cap on your out-of-pocket costs. That in itself could be less than annual premiums for a supplement. It sounds as though you would benefit from a meeting with a local insurance agent in your area that can help you navigate what may be a better option.
I was new to medicare in early 2013 and because I have been very healthy all my life chose a Medicare Advantage HMO. Shortly thereafter I developed a health issue, while residing out of state (as I began doing PT when I retired) and found that I made a huge mistake. “Some” of the medical including two operations were picked up by my home state HMO but the rest was up to me.
Therefore, from what I can determine, a Supplemental plan w/prescription coverage might be the most logical choice if I am to continue this dual state living arrangement (NYS/SC)?
Michael, If I was in your situation, I would strongly consider that even though your out-of-pocket expenses will be limited by your plan’s Maximum Out-of-Pocket amount (MOOP). Since you were new to Medicare in early 2013 and have been enrolled in the Medicare HMO for less than one year, you are entitled to Guaranteed Issue Rights to buy a Medigap policy.
can I switch from one advantage to one supplementary plan and years later change supplementary to advantage??
Chung, Theoretically… yes. The only stumbling block to that would be if you couldn’t pass underwriting to get the supplement initially. Otherwise you are able to switch each year.
My mother is 87 and recently entered a nursing home. The nursing home is requesting that she change from her current Medicare Advantage plan to standard Medicare. I am not clear on why they feel that would be advantageous. Can you provide any insight?
Caroline, First I would ask them why. My guess would be that the in-house providers are no longer in the plan’s network.
My wife is on Medicare and has been thinking of going to an advantage plan. She recently has been diagnosed with lung cancer. What would be the best for her situation? Go with an advantage plan or stay with medicare and get an additional supplemental plan?
Jake, I’m sorry to hear that you and your wife will be facing this. My wife is a breast cancer survivor and I can sympathize with your situation. If your wife is not in her Medigap Open Enrollment Period or is entitled to http://affordablemedicareplan.com/pre-existing-condition-buy-medigap-guaranteed/ she will have a difficult time passing medical underwriting for a supplement. If she has the option to get a supplement, it would be a good choice. She will not be subject to network restrictions and may avoid some potentially high out-of-pocket costs. The main issue is network restrictions. If she opts for the Advantage Plan, she may severely limit her options when it comes to specialists.
I am 58 years old and am on Social Security disability. I am signed up for Medicare Part A & B effective November 1st 2013. Now looking for a supplement or advantage plan. I don’t know which way to turn. Which pays first Medicare or the supplement/advantage plan? I am looking at the Humana advantage plan because it has vision, hearing & dental and will cost $51 a month. I am going to move to another state this next year and will need to change. How hard is it to change if it is not during the open enrollment plan?
Connie, If you have Medicare and a supplement, Medicare pays first. But, you should know that many States do not require insurance companies to offer Medicare supplements (Medigap) to people on Medicare who are under 65. Check with an agent in your State. If you can get a supplement, expect to pay a lot more than someone who is 65. I know that’s not fair!
A Medicare Advantage Plan works differently than a supplement. The insurance company administers your Medicare benefits which are paid by the plan. If you have an Advantage plan and move you are entitled to a Special Enrollment Period. There’s no hassle in changing, as long as you have suitable options in your new location.
Not to sound too ignorant, what is a maximum out-of-pocket limit of $6,750 on a Medicare Advantage Plan? Is this a form of catastrophic insurance in the event my costs exceed that figure?
Dennis, You’re exactly right. Plans can set the figure lower if they wish to make their plans more attractive to potential members. Keep in mind that with original Medicare, you don’t have an out-of-pocket maximum. For outpatient for example, it’s 20% on you, with out a cap. So the maximum out-of-pocket is not a bad benefit.
My grandparents are paying a over $6000 a year for their supplements and part D insurance premiums–that’s not talking deductibles. At first glance the advantage plans look great, because of the savings. However, I don’t know if they will be losing the type of care they can get. Both are physically well but have medications. My grandfather has dementia and I do anticipate it to get worse.
Paula, If you are responsible for helping your grandparents you should meet with an agent or broker and let them do a needs analysis. A Medicare advantage Plan may or may not be a good option. If you do not have an agent, ask your automobile or homeowners agent for a referral.
David, I have a Mutual of Omaha supplemental Plan F which I have been very happy with and a prescription plan also. What do people do who need dental coverage since these plans do not offer dental or vision.
My 82 year old father was diagnosed with multiple myeloma last month. His meds cost $10,000/Rx. He had an HMO with a drug plan having an annual $9,000.cap. The drug company provided his med at no cost for December and suggested we look into another Rx plan. The drug company will continue to assist with his medicine. So since we could not get Plan D while he was with the HMO we switched him to Medicare and added Plan F along with Plan D. It was fairly pricey but with some help from us kids he can pay the monthly premiums. I know it is late to ask this (since we already did it) but after weeks of looking into it we decided to go the way we went. Did we do the right thing? Dad will not get better but with proper meds we hope to have him a round for a few more years…
CJ, You can’t go wrong with Plan F and as along as the Part D covers his meds, you should be fine.
Kay, You will either pay out of pocket for dental work or buy a dental policy. But the problem with dental insurance is that aside from the premiums, you will generally have a deductible and an annual cap on benefits. If that wasn’t bad enough, many procedures require a waiting period before they are covered. I’d plan on paying out of pocket if I were in your shoes.
I got on this site by asking the question regarding Advantage vs Supplement Plans…..
I have a Medicare/Supplement Plan F and so far it has been working for me….I’m 82 and have friends that have so many questions that were answered by you on this site…
Assunta, Thanks for the kind words… I’m glad I could help.
My husband is 64, disabled, will have Medicare A & B as of Feb 1, 2014, and he’s also on my insurance through work (it will be primary because over 100 employees), and medicare will be secondary, so when he turns 65 would he be better off to come off mine and go with just Medicare A & B, get a supplement, &drug plan, or stay on mine? He takes a lot of meds because he’s a successful transplant patient more than 11 years ago. My insurance has a co-pay on meds from $5 a month to $30 a month. Which would be the cheaper way out (stay on mine at 65 or go with a supplement, & get a drug policy also. My understanding there is some coverage gaps to meet.
Elizabeth, It would be best to have an agent who is licensed in your State review your current coverage and explain your husband’s Medicare supplement options as well as conduct a needs analysis for Part D coverage to best answer your question. Some things to take into consideration will include: If lower premiums with your current coverage (once he’s removed) will help cover potentially higher drug costs with a Part D plan, if a supplement that allows the use of any provider will be more beneficial than a network-based plan (assuming that’s what you have), whether a comprehensive supplement like Plan F will save you money when he uses his plan (versus deductibles, coinsurance and copays with employer group coverage).
You should also consider that he will be in his Open Enrollment Period and can choose any plan offered without being subject to underwriting (except for a short preexisting period clause) and the possibility that current or future legislative (or executive order!) changes could adversely impact your current employer group coverage. In short, I’d think beyond the difference in drug costs to make such an important decision.
I’m looking for some advise. I am 64 and will be eligible for disability medicare on March 1. I will be 65 in July. I am confused as to what direction to go in, regarding a supplemental plan or advantage plan. I met with someone who gave me rates on supplemental plus drug plan. It will cost about 500.00 or more per month for Part B, the supplement and Rx coverage. I am meeting with someone to go over the advantage plans tomorrow. The rate for supplemental is very high for me. I have MS and on a very expensive drug which I now get free through the MS society because of my income level. The drug plan will be to high if this drug is included, so I’m will check to see if I can still get help obtaining it. I also have high blood pressure meds which I get for 60.00 every 3 months. I want to make sure that I use my money wisely and make the correct decision. The MS has been stable for many years and I do not have any other major health issues right now. Can you shed any light as to what to look for in my situation when choosing the right way to go.
Thanks for any help you can give me.
Judy, It seems as though a lot hinges on whether or not the MS Society will continue to offer your required med for free. If they do and your budget is limited as you have indicated, you may be able to find a Medicare Advantage Plan that will suit your needs. Plan are offered County by County and depending on where you live, you may or may not have a good selection of plans. Visit medicare.gov to review plans in your area. Watch this short video if you need help navigating the Medicare website.
If you find that your MS drug is not going to be offered through the MS Society and you still feed that an Advantage Plan will be better for your budget, be absolutely certain that the drug is covered in the plan formulary. Many Medicare Advantage Plans include basic drug formularies that are less than comprehensive.
When shopping for a plan, recognize that there are captive and non-captive agents. A captive agent represents only one company. A non-captive agent may represent multiple companies. It’s better to compare several companies whether you thinking of a supplement or medicare Advantage plan. Also, you mentioned eligibility March 1 due to disability, but will be 65 in July. Most companies offering a supplement will charge more for someone under 65 who is eligible due to a disability than they will for a 65 year old. Re-visit the agent you spoke with and get a rate as if you were 65. If you decide on a supplement, your rate may be high only for a couple of months.
If you need help locally, you can always meet with someone from your local Area Council on Aging office. The provide a free service for people who are Medicare eligible.
Dear Mr. Forbes: Thanks for all the answers; I don’t have to ask anything after reading through Q&A on your page. I will be 65 in June, 2014. Thanks again for the education. God bless.
I wish I had understood this difference earlier. For my mother her advantage plan served her well–minimal cost–until she had significant problems. We were severely limited in home health and skilled nursing facilities because few accepted her advantage plan. People may want to investigate what providers accept the advantage plan in their area, and then decide if they can live with the limited choices.
Joyce, Excellent advice. Too many people just assume that their providers will be in-network.
I understand that choosing Advantage as a plan is a one time only choice with no recourse to return to traditional Supplemental plans. Is that correct and do you see that as a detriment to Advantage since you’re locked in to future changes?
Earl, Enrolling in a Medicare Advantage Plan does not necessarily mean that you can’t go back to a supplement. When you enroll in an Advantage plan you are generally locked in for the year unless you take advantage of the dis enrollment period that begins January 1 and ends February 14. There are times when you have guaranteed issue rights with a Medicare supplement and you can apply for a Medicare supplement to begin when your current medicare Advantage Plan ends. In this case you would normally be subject to medical underwriting.
Please correct the spelling of the word “your” to “you’re”. Insurance agents should be able to spell or at least have an editor.
Many Medicare Advantage plans are network based plans, so you may need to check out the plans network to insure that your happy with the providers.
My husband is disabled (age 63) and is eligible for Medicare in Dec of 2014. From what I read, he is not eligible for a Medigap policy. We have enrolled in a Medicare Advantage Plan but will that be enough insurance. Other than back issues, he is basically healthy.
Cyndi, It sounds as though you don’t have any other options. There are millions of people with an Advantage plan and the vast majority are happy. The key is to research the plan thoroughly before you enroll. When your husband approaches 65 he will have an Open Enrollment Period for Medigap. He may want to switch at that time. here’s an article about Medigap Open Enrollment.
terry, Why can’t a person that qualifies for extra help get a medicare supplement instead of an advantage plan? They say you can not even consider it.
I am 66 and signed up for Plan F High Deductible. My maximum out of pocket expense is about $2200 per year but the policy cost me less than $500 per year. A normal Plan F policy would cost about $2100 annually. My reasoning is that every year that I only spend a few hundred on co-pays puts me way ahead – in the thousands in savings. Worse case in the event that something terrible happened to my health I would only be out a few hundred extra above the normal Plan F pricing. It’s worth the chance and odds. I had to hunt high and low to find an agent that would sell me that policy. Is that because there is almost no commish in the premium?
George, The low commission is probably one good reason but I wouldn’t put it all on the insurance agent. Agents may be captive (representing only one company) and may not even have the option available. Insurance companies are not very aggressive in offer the plan either.
David — I was tickled to see Linda chastise you for incorrectly writing “your” instead of “you’re.”
Why was I tickled? Because Linda called you out and then did the same thing later in her email. Nice job Linda!
FROM LINDA —— Many Medicare Advantage plans are network based plans, so you may need to check out the plans network to insure that your (YOU’RE) happy with the providers.
Nice catch John!
My husband and I have medicare A and B We have an HMO medical policy $400.00 a month with my previous employer (retired) the out of pocket expenses are $6,868.00 for family. With this plan we pay co-pays and/or the Co-insurance plus prescrition co’s Recently been thinking about changing to individual plans F and individual part D It seems we pay so much in medical expenses !! Wondering maybe changing might save us money (Also I qualify for extra help with my part B) Could use help making decisions
Joy, If you don’t have an agent that you are working with I would recommend giving ehealth a call at 888 310-0376. They have agents licensed in all States and can answer your questions and share some options with you.
Hello Mr. Forbes: Thank you for being very helpful about medicare planning. I learned a lots from reading through this website. I will be 65 by may 2018, so far what I learn is suplement F is the best if i can afford, am I right ? I have high blood pressure+ Stent post MI + high lipidemia. I would say I am considerable healthy, only need to visit Dr. once a year for yearly checkup.
Plan F is the most comprehensive. Plan G is a good alternative as well.
I have Humana Gold Plus.I pay $0 per month. Most copays are $0. Can I do better than that?