If you are new to Medicare or are looking to make a change to your current plan, you may wonder which plan is right for you. When deciding which plan to enroll in, your first step is to decide between either a Medicare Supplemental (Medigap) or Medicare Advantage plan.
Since there are many differences between these plans, understanding which type of coverage is right for your situation is essential when enrolling.
Our friendly independent insurance agents at McKnight & Mcknight summarize what you need to know.
Medicare Advantage Vs. Medicare Supplemental Insurance
Medicare Advantage and Medicare Supplement Insurance are both forms of health insurance designed to help people pay for medical services. However, the two plans have different structures and provide different types of coverage.
Medicare Advantage Plans
Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide all Part A (Hospital Insurance) and Part B (Medical Insurance) benefits.
This type of plan includes additional benefits at no extra cost to the policyholder including:
- Prescription drug coverage
- Vision coverage
- Hearing aid coverage
- Dental care covered
It also provides flexibility in terms of choosing providers within the network as well as more cost-sharing options when seeking medical attention. The caveat? Your current doctor may not accept the plan if they aren’t in the plan’s network.
When you enroll in a Medicare Advantage Plan, you agree to pay higher out-of-pocket costs in exchange for a lower monthly premium.
Is a Medicare Advantage plan right for you? Here are the pros and cons:
Pros:
- Additional benefits such as dental, vision, drug, etc.
- Low monthly premiums
Cons:
- Higher maximum-out-of-pocket costs (up to $10,000)
- Restrictions to doctors and hospitals
- Coverage does not travel with you
- Most plans require referrals
- Requires you to update/change plans every year
Bottom line: These plans are ideal for those who want low monthly premiums, and do not mind paying more out-of-pocket when visiting doctors and hospitals.
Medicare Supplemental Plans
Medicare Supplement insurance, also known as Medigap, is an additional policy that helps supplement Original Medicare coverage for out-of-pocket expenses like deductibles, coinsurance, and copayments.
Medigap plans allow you to predict your costs and choose a provider, wherever you are.
The best part? When enrolled in a Medigap plan, there is no network of doctors to which you must adhere. You can receive coverage from any doctor or hospital that accepts Medicare across the United States and its territories.
Is a Medigap plan right for you? Here are the pros and cons:
Pros:
- Low to no out-of-pocket costs
- No network restrictions
- No referrals
- Foreign travel emergency coverage on most popular plans
- Coverage travels with you throughout the U.S.
- Standardized benefits
Cons:
- Higher monthly premium
- Additional plans for dental, vision, and prescription are required
Bottom Line: These plans are ideal for those who want low out-of-pocket costs, coverage that travels with them, predictability, and the freedom to choose their own providers.
“So helpful in walking through the maze of Medicare insurance information. Bob made the process very simple and efficient. I was able to ask questions, check out different choices, and choose the best option for me. Helpful and professional!”
-Julie B.
How Do I Choose the Right Plan?
When it comes to choosing the right plan, the biggest complaint we hear from clients when enrolled in Medicare Advantage plans is that they are unable to accurately predict their out-of-pocket costs.
On the other hand, we don’t hear as many complaints about Medicare Supplement plans. Most people stick with these plans due to their ease and reliability. Further, the option to go to any doctor that accepts Original Medicare is a major benefit for those with Medicare Supplement plans.
So which plan is better? Well, it all depends.
Since Medicare does not offer a one-size-fits-all plan, the best route for you is to choose a policy that best meets your healthcare needs.
To recap:
- Medicare Advantage plans are a great option if you hope to save on monthly premiums and receive additional benefits while paying out-of-pocket at your doctor’s office. But remember, there are stricter doctor networks and referrals.
- Medicare Supplement plans are the best option if you want predictability with your healthcare, but are comfortable paying higher premiums in exchange for lower out-of-pocket costs. Remember, you can choose any doctor, avoid referrals, and choose a doctor in any U.S. state.
Learn More > Transitioning from Health Insurance to Medicare
Explore Your Medicare Options
Medicare Advantage and Medicare Supplemental Insurance are two very different plans that provide unique coverage. It is necessary to understand the differences to make the right choice for your individual needs, the costs associated with both plans, as well as any additional benefits you may be eligible for.
Ultimately, it’s crucial that you select a plan that covers your healthcare expenses while staying within your budget. Consulting with our friendly insurance agents at McKnight & McKnight can help you make this important decision!
