Medicare Supplement Vs. Medicare Advantage

Considering Medicare Advantage Or Medicare Supplement

 

Millions of Americans aged 65 and older are enrolled in Original Medicare, which covers inpatient hospital costs (Part A) and outpatient medical costs (Part B). But for a growing number of people, Original Medicare is not enough.

 

To get the additional coverage to meet their needs, many turn to Medicare Supplement (Medigap) and Medicare Advantage (Part C) plans. Both plans can help lower out-of-pocket costs, plus Medicare Advantage offers benefits not included in Original Medicare.

 

The following key differences and considerations can help you decide whether Medicare Supplement vs. Medicare Advantage is right for you.

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Medicare Supplement (Medigap) Vs. Medicare Advantage

 

Features And Considerations

 

 

Medicare Supplement

 

 

Medicare Advantage (Part C)

 

 

Consider if …

 

 

You want to supplement Original Medicare to control costs.

 

You want an all-in-one healthcare plan with additional benefits.

 

 

Key Features

 

 

Helps pay for copays, deductibles, and coinsurance for Original Medicare

 

Part A:
  • In-patient hospital costs; and
Part B:
  • Doctor visits and outpatient costs
  • See any doctor or hospital in the U.S. that accepts Medicare patients1
 
Does not cover:
  • Prescription drugs
  • Dental
  • Vision
  • Hearing

 

 

Combines Original Medicare with routine Dental, Vision, and Hearing coverage.
  • Most plans include Prescription Drug (Part D) coverage.

  • See doctors in-network or out-of-network depending on the plan.2

  • May have improved health outcomes and lower out-of-pocket costs compared to fee-for-service Medicare programs.3

 

 

Cost Considerations

 

 

Your monthly premiums may be higher compared to Medicare Advantage, but your annual out-of-pocket costs may be lower.
 

$97 - $3735

Monthly Premium Range
 

Helps cover copays, coinsurance, and deductibles, so your costs are more predictable.

 

 

These plans protect you with yearly limits on your out-of-pocket costs for medical and hospital care.

 

$18

Average Monthly Premiums

 

With copays4

 

What Is Medicare Supplement (Medigap)?

 

As the name suggests, Medicare Supplement, also known as Medigap, supplements Original Medicare to help pay for out-of-pocket costs like deductibles, copays, and coinsurance.

 

To help you decide whether Medicare Supplement is the right fit for you, here are some tips, features, and factors to consider.

 

Scenarios For Choosing Medicare Supplement

 

   You travel or live in different locations in the U.S. throughout the year
 

   You want the freedom to choose any doctor or hospital the accepts Medicare patients1
 

   You prefer not having to get referrals to see specialists
 

   You don't mind adding separate plans to cover prescription drugs, dental, and vision coverage

 

Coverage Details

 

As noted, a Medicare Supplement plan helps to pay for Original Medicare deductibles, copays, and coinsurance, but doesn’t cover prescription drugs, dental, vision, or hearing care.

Plans are standardized by the federal government, like these offered by Anthem:

 

 

Plan A

 


Plan F

 


Plan G

 


Plan N

 

 

Basic coverage, lower premium, deductible for hospital care

 

 

Has the most comprehensive coverage of Original Medicare costs. Limited to those eligible for Medicare prior to January 1, 2020

 

 

Broadest coverage for those newly eligible for Medicare. Covers all Original Medicare costs except the Part B deductible

 

 

Lower premium, some copays, small annual deductible

 

Anthem offers extras like prescription savings, discounts on vitamins and weight loss programs, and SilverSneakers® fitness memberships.

Enrollment Factors

 

   Need Original Medicare Parts A and B to enroll.
 

   Best time to enroll is your Initial Enrollment Period, starting three months before you turn 65, and ending three months after the month you turn 65.
 

   You also can enroll during the Medigap Open Enrollment period, starting the first month you have Medicare Part B and you're 65 or older.
 

  If you sign up during your Initial Enrollment or Medigap Open Enrollment Periods, you can't be denied coverage or charged higher premiums even if you have pre-existing health problems.

 

   If you enroll later or switch from a Medicare Advantage to a Medicare Supplement plan, you could be denied coverage based on pre-existing health conditions.

Costs

 

   Low or no monthly premium, but copays could add up with costly care

 

   Once enrolled, you'll need to continue to pay your monthly Medicare Part A and Part B premiums. For most people, Part A is $0.
 

 

Explore Anthem Medicare Advantage Plans 

 

What Is Medicare Advantage?

 

Medicare Advantage plans have comprehensive coverage with $0 or low monthly premiums.

 

The following scenarios and details can give you additional knowledge and confidence when considering Medicare Advantage (Part C) plans.

 

Scenarios For Choosing Medicare Advantage

 

   You want a low monthly premium combined with a single all-in-one plan, along with the ease of dealing with a single insurance company.
 

   Your doctor is in-network, and your prescription drugs are covered by Medicare Advantage.
 

   You want to upgrade your current Medicare Supplement plan but were denied due to a pre-existing condition. With Medicare Advantage, you can't be denied for health reasons.

 

 

Coverage Details

 

As noted, Medicare Advantage plans provide comprehensive coverage for hospital and medical care, along with routine dental, vision, and hearing care. Most plans also include Prescription Drug (Part D) coverage.

 

Choose Between A Health Maintenance Organization (HMO) And A Preferred Provider Organization (PPO).

 

   Health Maintenance Organization: Lower premiums and copays, but require in-network doctors, and some require referrals to see specialists

 

   Preferred Provider Organization: Higher premiums and copays, but you can see out-of-network doctors, with no referrals for specialists

 

Make sure your doctor is in-network if you choose an HMO plan. Even if you choose a PPO with out-of-network coverage, your costs will be lower if your doctors are in-network. Also, check to ensure your prescription drugs are included before choosing your Medicare Advantage plan.

 

Special Needs Plans (SNPs) provide support, benefits, and coverage for those who qualify based on chronic medical conditions or low incomes. 

Anthem offers other benefits, including spending allowances for over-the-counter health items, groceries, utilities, transportation, and more, as well as SilverSneakers® fitness memberships. (Benefits may vary based on plans, locations, and individual conditions.)  

 

 

Enrollment Factors

 

You'll need Original Medicare Parts A and B to enroll. Here are key details about when to enroll.

 

Initial Enrollment Period

 

 

Annual Enrollment Period

 

 

Medicare Advantage Open Enrollment Period

 

 

Special Enrollment Period

 

 

Most people enroll during the Initial Enrollment Period, which includes the three months before the month of their 65th birthday through the three months after their 65th birthday.

 

 

October 15 to December 7

 

You can shop, switch, and drop Medicare plans during this period.

 

 

January 1 to March 31

 

Allows you to change your Medicare Advantage plan once if you're not happy with the plan you chose during the Annual Enrollment Period.

 

 

 

If you have a qualifying life event, like moving out of your plan's service area or losing coverage via your employer.

 

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Read Our Other Medicare Articles

‡Original Medicare: Part A (Hospital Insurance) and Part B (Medical Insurance)

 

1Medicare Select Plans are the exception. For non-emergency services covered by Medicare, you must use a hospital in our Select hospital network to receive full benefits.

 

2Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

 

3Source: Journal of the American Medical Association Open Network https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799376   

 

4https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-lower-premiums-medicare-advantage-and-prescription-drug-plans  

 

5Medicare Supplement Plan G for a 65-year-old female non-smoker in Kentucky. Source: Explore your Medicare coverage options (accessed May 2023) Medicare.gov .

 

Anthem Blue Cross and Blue Shield is a Medicare Advantage plan with a Medicare contract. Anthem Blue Cross and Blue Shield is a D-SNP plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal. 

 

For Medicare Supplement only: Not connected with or endorsed by the U.S. government or the federal Medicare program.