Medicare Supplement Versus Medicare Advantage–A Simple Chart

Medicare Supplement (MS)

Medicare Advantage (MA)

Premium/Out of Pocket

• Monthly Premiums are generally higher, but some plans can be priced comparably to certain MA plans.

• Government specifies three different rate structures.

• Co-payments are eliminated with some plans.  Some plans do feature co-payments, however.

• Premiums are lower on the surface–Part B premium is still being paid (see government funding).

• Rate increases are dependent upon the company itself.

• Generally, a co-payment is due each time you are seen medically.

Deductible

• “High Deductible” F plans for 2015 is $2,080 per year.

• Part B is still working–meaning you pay any uncovered Part A or B deductible and 20% (exceptions are plans with cost sharing).

• High deductibles can be up to $10,000 per year (or more if out of network).

•  Deductibles work like group insurance.  You pay your entire deductible before benefits start (in most cases).

Relation to Original Medicare

• MS plans go hand in hand with Original Medicare Benefits. See here for what Medicare Covers.

• Can be structured to have little or no out-of-pocket when paired with Medicare Parts A and B.

• Replaces Original Medicare–benefits are mirrored, but not exact.

• Because it is outside of Original Medicare A and B, out-of-pocket costs are usually present.

Standardization

• Standardized by letter–no matter what company presents the letter-though companies can offer new or innovative benefits to improve upon standardization (like preventative care riders).

• Not standardized.  When purchasing plans, all aspects must be reviewed.

Network

• No network.  Usable throughout the United States.

• If facility does not accept Medicare’s assignment, patient is liable for excess charges (up to 15% above Medicare’s assignment if not covered by supplement-Plans F and G Cover this).

• Network is specified by the company running the plan.

• If not in network, higher deductible applies–sometimes up to 60% more for the same services OR 100% of the cost.

Government Funding

• Completely Separate.  MS plans are funded completely by subscribers.

• Government funding used to pay for your Part B premium, leaving the subscriber with sometimes $0 premium for the MA plan.  Funding has been disappearing more and more each year, so benefits, networks, and/or premiums are changed to fit that lack of funding.

Enrollment

• Once you enroll, you don’t have to enroll again unless you want to change plans or companies for your supplement.

• Medical qualification needed if changing outside of enrollment periods.

• Open enrollment happens every year–you must make a decision as to which company/plan you want each time.

• Changing companies and plans can occur each year, no medical qualification needed.

Other Benefits

• Usually do not contain prescription coverage, so Part D (or other credible coverage) is needed.

• MS may offer innovative or additional benefits–depends on the company (like preventative riders).

• MA (MAPD) may offer prescription alongside, so Part D is included.  However some plans do not include prescriptions.

• All additional benefits vary from company to company, including dental, vision, or wellness.

Travel?  Are you a “Snowbird?”

• Usable in any State.   Since there is no network, you don’t have to worry about coverage.

• Some MS plans offer foreign travel benefits.

• Generally regional–travel has a high chance of being out of network.

• No foreign travel benefits.