Getting to the age of 65 and reaching eligibility to enroll in medicare is an adult milestone. One that may be positive or negative depending on how you view the aging process. You may be looking forward to enjoying the fruits of your labor by enrolling in medicare health insurance or you’re begrudgingly enrolling because you don’t quite feel old enough. But no matter which category you fall into, one thing remains true: Medicare plans can be confusing to understand and difficult to keep straight.
One point of confusion that is quite common is differentiating Medicare Advantage plans from Medicare Supplement plans. There are many common questions about the two. What is the difference between the two? Can you carry both? Which is better?
To help clear up some confusion and help you to make your choice, we’ve answered a few of your questions.
What is the main difference between Medicare Advantage and Medicare Supplement Plans?
Many find it difficult to understand the difference between Medicare Advantage plans and Medicare Supplement plans. But, much of the confusion comes from attempts to place these two types of plans in the same category.
It is more accurate to place Medicare Advantage in the same category as Original Medicare.
Original Medicare is a plan offered by the government that consists of Part A, hospital coverage, and Part B, medical coverage. There is also an option to enroll in a Part D plan for prescription coverage.
Medicare Advantage plans are offered by private insurance companies and consist of Part A and Part B coverage, as well as options for other coverages original medicare doesn’t cover such as prescriptions, vision, and dental.
Medicare Supplement Plans are not insurance plans in and of themselves. They are supplemental policies you can choose to enroll in alongside Original Medicare.
Why should I enroll in a Medicare Advantage Plan?
Your decision to choose Medicare Advantage over Original Medicare is a personal one that depends on your needs and preferences. Medicare Advantage plans often operate similarly to private health insurance where all coverage is rolled together under one plan. These plans also often include prescription coverage and extra coverage such as vision and dental or additional benefits such as gym memberships. Medicare Advantage plans operate on a network system and are great for those who live in a big city with a wide network. Advantage plans also have an out-of-pocket maximum. This can be helpful if you require many visits or procedures in a calendar year.
Why should I enroll in a Medicare Supplement Plan?
Medicare Supplement Plans exist to help you pay for out-of-pocket costs associated with Original Medicare. These costs include deductibles, copays, and coinsurance. Original Medicare does not have an out-of-pocket maximum, therefore having a supplement plan can make Medicare much more affordable.
Though there is a monthly premium for having a supplement plan in addition to the Part B premium, many enrollees prefer to have a predictable monthly cost, rather than surprise or fluctuating health care costs.
Can I enroll in Medicare Advantage and a Medicare Supplement plan?
No, you cannot enroll in a Medicare Advantage plan and a Medicare Supplement plan at the same time. Medicare Supplement plans are supplements to Original Medicare. Therefore, if you have enrolled in a Medicare Advantage Plan, you do not need to buy a Medigap plan.
Medigap plans cannot be used to pay coinsurance, copays, or deductibles of a Medicare Advantage Plan. In fact, it is illegal for someone to sell you a Medigap plan if you have a Medicare Advantage plan with no intention to switch to Original Medicare in the next 12 months.
Which plan is better?
Neither Original Medicare with a Supplement Plan nor a Medicare Advantage Plan is outright better than the other. The best choice depends on you and your particular needs and circumstances. Each person is different and has different needs, which is why both options exist.
For example, if you enjoy traveling and will need to see doctors in different locations, then Original Medicare with a Supplement Plan will be a better choice for you because it covers any doctor or hospital that accepts Medicare.
But, if you live in your forever home in a city with a broad network and you prefer to have all of your medical coverage rolled into one plan, then Medicare Advantage would be a good choice for you.
There are particular times when you can enroll in Medicare. Your open enrollment period for Medicare Advantage begins three months before you turn 65 and last for the 3 months after your birthday month. Then, each year from Jan 1-March 31 you are eligible to change your plan or switch plans.
Your open enrollment period for Medicare supplement plans begins the day you enroll in Original Medicare and lasts for the next 6 months. During this time you can choose to enroll in a Medicare Supplement plan and make changes without any penalty.
It is important to note that during this time, you cannot be discriminated against or penalized for your health status, but after the first 6 months from your initial enrollment period, you may be denied entirely or may not be offered the same plans depending on your health needs. Because of this, those with significant health needs often choose to enroll in Original Medicare with a Supplement Plan during their initial enrollment and choose to never change or switch plans.
Get Assistance with Enrollment
Trying to make sense of the alphabet of parts involved with Medicare can be confusing and time-consuming. At Patriot Insurance Brokers, our team is well-acquainted with the complicated lingo and timelines. We are available to discuss all of your questions, give advice based on your particular scenario, and assist you in enrollment to ensure that no steps are missed.
Schedule an appointment today to discuss all of your Medicare insurance questions.