Choosing the right insurance coverage is crucial to ensuring you have the coverage that is right for you at the best possible cost. However, making a decision on coverage can be difficult – especially when deciding between Medicare Advantage or Medicare Supplement insurance. Read on to learn more about Medicare Advantage and Original Medicare with supplement insurance policy, and find out if you can have both at a given time.
What is a Medicare Advantage Plan?
A Medicare Advantage plan is a type of Medicare health plan offered by a private, Medicare-approved insurance company. These plans, sometimes called “MA Plans” or “Part C” are bundled plans offered as an alternative to Original Medicare.1
Medicare Advantage plans include Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and may include Medicare prescription drug coverage (Part D).1
With a Medicare Advantage plan, most Medicare services are covered through your plan – but aren’t paid for by Original Medicare as a Medicare Advantage plan acts as an alternative to it.2
Rules and Limitations of a Medicare Advantage Plan
Like anything, there are some rules and limitations with a Medicare Advantage plan. For example, since most Medicare Advantage plans operate as HMOs or PPOs, most can only see doctors from within a specific list (generally called a provider network) – which doctors can leave at any time.3
In addition, some plans require prior authorization before seeing a specialist or receiving specialist care/procedures, and plans might not cover care given outside of the network’s geographical area.3
Medicare Advantage plans are renewed every year and may change or be discontinued.3
What is a Medicare Supplement Insurance Policy?
A Medicare Supplement insurance policy is a type of supplemental insurance policy that is sold by private insurance companies.4
It is designed to cover some of the out-of-pocket expenses, like copayments, coinsurance, and deductibles that Original Medicare does not cover.4
In order to be eligible for a Medical Supplement insurance policy, you must first be enrolled in Medicare Part A and Medicare Part B.4
Rules and Limitations of a Medicare Supplement Insurance Policy
Medicare Supplement policies are often more expensive than Medicare Advantage plans, but don’t require you to get prior approval before seeing a specialist, receiving specialist care, or having a specialist procedure done.3
There are no provider networks to contend with in Medicare Supplement, you can receive care from any provider in the country who accepts Medicare.
Can You Have Both Medicare Advantage and Medicare Supplement Insurance?
Unfortunately, you cannot have both Medicare Advantage and Original Medicare with a Supplement policy, meaning you’ll have to choose the coverage that best suits your needs. Here are some tips to deciding if a Medicare Advantage or Original Medicare with a Supplement policy is right for you.5
- Consider your budget - There is a notable difference in premiums between a Medicare Advantage Plan and Medicare Supplement Policy, with Medicare Supplement often having higher premiums. If you’re under a tight budget this is something to consider.
- Consider your physician - You may be inclined to choose a Medicare Advantage Plan or Original Medicare with a supplement depending on where you physical is listed. However, in the case of Medicare Advantage, physicians can drop from the list at any time. This can leave you without a familiar health care practitioner.
- Consider your location - Do you plan to spend half of your time in another state – or country? If yes, this could drastically impact your ability to get coverage.
- Consider any preexisting conditions - Having certain preexisting conditions or disabilities could impact the cost of coverage, determining which coverage you may be able to qualify for. Make sure to do your research before committing to a Medicare Advantage Plan or Medicare Supplement policy.
No matter what coverage you opt for, make sure you’re making the best decision for your unique circumstances. Remember, there is no one-size-fits-all to insurance, so what works for others may not work for you. Speak to a licensed insurance agent with any questions you may have to help you find the perfect coverage for your situation.
- Medicare.gov, How do Medicare Advantage Plans work?, n.d.
- Medicare.gov, Medicare Advantage Plans, n.d.
- Medicare.gov, Understanding Medicare Advantage Plans, n.d.
- Medicare.gov, What's Medicare Supplement Insurance (Medigap)?, n.d.
- Medicareresources.org, How to decide between Medicare Advantage, Medigap and Part D, 2019