While enrolled in Original Medicare, you have many options and choices to add to your Medicare coverage to offset some of the out-of-pocket costs you might be responsible for paying. If you’re enrolled in Original Medicare, you may need additional forms of coverage outside of Original Medicare to cover the costs you might otherwise be responsible for paying yourself. These costs can include covering the out-of-pocket cost responsibility that is your share, when enrolled in Original Medicare, or covering the coverage not offered with the Original Medicare plan like dental and vision coverage, prescription drugs, overseas health coverage, etc.
Two of the most popular choices are Medicare Advantage and Medicare Supplement Insurance policies. However, there are significant differences between the two types of coverage that you must know before deciding to enroll in one over the other. Finding this out will help you establish which one will suit you best as an individual. Read on to learn the main differences between the two types of coverages, how each policy operates, and which type of policy will work best.
The Core Differences
There are a handful of core differences between these two types of coverage. Keep in mind that a Medicare beneficiary can have either a Medicare Supplement Insurance policy or a Medicare Advantage Insurance policy, but not both.
While using a Medicare Advantage policy, this coverage will be your primary source of insurance coverage, and in a sense, will take over your Medicare plan. When enrolling in a Medicare Advantage, you accept the coverage and plan structure as your primary source of insurance coverage. Keep in mind that Medicare Advantage coverage is an entirely different form of insurance coverage than your Original Medicare plan. These plans are thought of as all-in-one insurance plans and can include coverage not offered with Original Medicare. The plans can cover things like dental, vision, hearing, prescription drugs as a Part D, gym memberships, rides to and from your doctor, over-the-counter drug benefits, and many other great coverages that are not included in your Original Medicare policy. Keep in mind that the coverage offered will vary from plan to plan.
Medicare Advantage plans are essentially an alternative to your Original Medicare. If you enroll in a Medicare Advantage plan, you are still in a Medicare program. However, you’ll get your Medicare benefits through your Medicare Advantage plan instead of through your federally administered Original Medicare program. Keeping this in mind, your Medicare Advantage plan will now be your primary insurance, instead of Original Medicare. This means that the plan will have its unique coverage and cost-sharing structure and may include coverage not offered under Original Medicare.
With Medicare Supplement Insurance, you’re using your Original Medicare (Parts A and B) first. The cost-share that is leftover is being shared by you, for your cost share, according to the Medicare Supplement plan rules, and by the Medicare Supplement policy, according to the plans structure and coverage rules and specifics, for their cost portion. These policies coverage’s cover the part that is your cost-sharing responsibility according to Original Medicare’s rules for cost-sharing. However, if you need additional coverage such as prescription drugs, dental, vision, hearing, or anything not covered with an Original Medicare plan, you will need to enroll in a separate coverage plan. These are not offered in a Medicare Supplement policy.
Keep in mind that when you purchase a Medicare Supplement Insurance plan, you are still enrolled in Original Medicare. Medicare pays for your healthcare bills primarily, while the Medicare Supplement plan covers certain cost-sharing expenses according to policy rules and guidelines such as copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies might help with other costs not covered, like Part B excess charges or emergency medical coverage you need while traveling out of the country. Just remember that Medicare Supplement Insurance plans can only be used to pay for Original Medicare costs and cannot be used with, or in conjunction with, Medicare Advantage plans.
Medicare Supplement Insurance Benefits
There are about ten different Medicare Supplement Insurance plans available in most states, and each plan type is designed by a separate letter. Coverage is standardized across each plan letter. You will get the same benefits for Medicare Supplement coverage within the same letter category, no matter what insurance company you buy from. However, even if the primary benefits are the same across plans of the same category, premium costs might vary by your insurance company and location.
Medicare Supplement Insurance plans cover your out-of-pocket costs not covered by Original Medicare, like copayments, deductibles, and coinsurance. Medicare Supplement Insurance plans don’t include prescription drug benefits. If you do not already have reliable prescription drug coverage, you should consider buying a stand-alone Medicare Part D Prescription Drug Plan to assist you in covering the costs. Also, Medicare Supplement insurance plans usually do not offer extra benefits like vision, dental, or hearing coverage beyond what’s already covered by Medicare.
Medicare Advantage Plan’s Benefits
Private insurance companies have a little more flexibility in designing Medicare Advantage plans and can add extra benefits to the plans they offer. This means you have to be a bit more careful when comparing policies to make sure you don’t overlook anything. As mentioned earlier, Medicare Advantage plans allow you to get coverage for those benefits beyond your Original Medicare. These plans can include dental, vision, hearing, prescription drug coverage, and additional benefits according to plan specifics. Usually, under Original Medicare, you would pay for these services out of pocket, unless you have other insurance. If you do decide to enroll in a Medicare Advantage that has a Part D Drug plan for prescription drugs, the plan will give you the convenience of having all of your Medicare benefits administered through one plan.
For more information on which plan works the best for you based on your current coverage, give Healthcare American a call today for some expert help!
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