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Medicare Supplement / Medicare Advantage Which Option is Right for Me?

by | Feb 23, 2013 | Toni Says

Dear Toni:

Can you please explain to me which Medicare option is better?

  • Medicare with Medicare Supplement plus a (Part D) Drug coverage or
  • Medicare Advantage Plan

I am having difficulty in comparing the two options on an apple to apple basis.   Thanks, Dale…  Sugar Land, TX

 

Hello Dale:

Choosing between a Medicare supplement and a Medicare Advantage plan can be very confusing.  To search which option is best for you takes time.  I would first talk with your doctor or specialist about which option to pick:1) Medicare with a Medicare Supplement and a standalone Part D Medicare prescription drug plan or 2) Medicare Advantage plan with a Part D Medicare prescription drug plan. Always take your time when trying to decide.

Let’s discuss the difference in the two types of Medicare options.  On pages 57-80 in the 2013 Medicare & You handbook explains what are a Medicare Supplement and a Medicare Advantage plans.  The handbook does not compare the differences with the plans.  Some of the differences between a Medicare Supplement and a Medicare Advantage Plan are listed below:

Medicare Supplement:

  1. A Medicare Supplement works directly with “Original Medicare”. Medicare will pay its share of the Medicare-approved amount for Medicare covered healthcare costs. Then your Medicare supplement will pays its share.
  2. With a Medicare Supplement you chose which doctor, hospital, home health agency, skilled nursing facility, etc that accepts Medicare assignment for your healthcare.
  3.  The downside to a Medicare Supplement is that you have a monthly premium. Medicare does not pay any of the monthly premiums for a Medicare supplement.  The Medicare supplement premiums may increase every year.
  4. You may enroll and will pay separately for a “Stand alone” Medicare (Part D) Prescription drug plan. Call 1/800-MEDICARE or go online to www.medicare.gov  to find out which Medicare (Part D) Prescription Drug plan covers all of your prescriptions and is the most cost effective plan for you. You can enroll in that plan at that time.

Medicare Advantage plan: 

  1. To qualify for the plan:  a)You must be enrolled in both Medicare Parts A & B…b)Live in the service area 6 months out of a year…c)Not have end stage renal disease (kidney dialysis)
  2. When you choose a Medicare Advantage Plan, then Medicare pays the insurance company a certain amount every month for your care as long as you are on the plan. Your Part B must always be in effect.
  3. When you go to the doctor or visit your pharmacist, you must only use your Medicare Advantage insurance card, not your Medicare card.
  4. A Medicare Advantage Plan must provide all of your Part A and Part B benefits and some Medicare Advantage Plans have Part D prescription drug plans included.
  5. A Medicare Advantage Plan may have a zero to low dollar premiums.
  6. With a Medicare Advantage plan, you may have different co pays, co-insurances or deductibles to pay and have maximum out of pocket expenses to meet.
  7. Medicare Advantage Plans may offer extra benefits such as gym memberships, dental benefits, transportation and other additional benefits.
  8. Many healthcare facilities, such as MD Anderson accept very few Medicare Advantage plans.  Call your specific provider or facility and make sure they accept which Medicare Advantage plan you want to enroll in. Find out if the Medicare Advantage plans you are researching are an in network or an out of network provider. (Very Important)

Toni King is advocate/consultant for those “Confused about Medicare. Visit www.tonisays.com and “like” ToniKingSays on facebook

 

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