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Medicare Advantage

How is Medicare Advantage Different from Medicare Supplement?

Medicare Advantage and Medicare Supplement (or MediGap) plans haven’t always been around. To start, Medicare only had two elements – Medicare Part A, or hospital insurance, which provided coverage for hospital stays and some other medical facility expenses; and Medicare Part B, which provided benefits for doctor visits and other specified healthcare costs. Together these elements are often called “traditional Medicare.”

Acknowledging the gaps in coverage that evolved due to advances in medical science, the government started developing additional plan options for enrollees who wanted to be prepared for these additional charges. So what differs between Medicare Advantage and MediGap plans? Let’s compare them.

What is a Medicare Advantage plan?

Medicare Advantage (or Medicare Part C) began in the late ’90s to help provide personalized care options for people and possibly help them save money in spite of rapidly rising medical costs. To do this, the government turned to private companies to develop plans that would meet clear cut criteria established by Medicare. Essentially, these criteria sought to protect seniors from carriers using deceptive business practices. Before any Medicare Advantage plan can be offered, it must receive approval from Medicare.

What does Medicare Advantage cover?

All Medicare Advantage policies are required to provide the services covered by customary Medicare (Medicare Part A and Medicare ​Part B). They may, however, offer a number of additionalbenefits. Some of these plan benefits can include:

  • Dental care coverage
  • Eye care coverage
  • Hearing care coverage
  • Worldwide urgent care and emergency coverage
  • Mail-order pharmacy program
  • Wellness and fitness programs
  • 24/7 nurse line

What is a Medicare Supplement Insurance plan?

Medicare Supplement Insurance policies (MediGap plans) have very specific options designed to help different groups of seniors, based on their needs. You might want to check into these plans if you’re a senior who …

  • can meet many of your healthcare needs through traditional Medicare.
  • has additional medical needs in addition to what traditional Medicare covers.
  • is looking to contain medical costs.

What do MediGap Plans cover?

Medicare set up MediGap plans with certain sets of defined features. These policies may offer help with some or all of the items below:

  • Medicare Part A Deductibles
  • Medicare Part B Deductibles
  • Coinsurance and excess fees from your care provider
  • Blood transfusion costs
  • Hospital stay costs above and beyond what Medicare Part A covers
  • Coinsurance for hospital and nursing home stays
  • Preventive care benefits
  • Foreign emergency medical benefits
  • A specified amount of prescription drugs your care provider prescribes for you

What may be more noteworthy is what MediGap plans do not cover, including

  • Prescription drugs
  • Long-term care
  • Skilled nursing facility confinements over what Medicare Part A covers
  • Routine dental, eye, or hearing care
  • Hearing aids
  • Glasses 
  • Private-duty nursing

How are Medicare Advantage Policies different from MediGap Policies?

The main difference between Medicare Advantage and MediGap is that there are multiple benefits a Medicare Advantage plan can offer over a MediGap policy. You’ll need to determine whether you actually will make use of these benefits to be sure they’re worth trying to get. If you are going to use them, fine: you’ll want to be sure they’re part of the plan you select.

One more difference between Medicare Advantage plans and MediGap plans is that quite a few Medicare Advantage plans offer prescription drug coverage. MediGap plan participants are required to enroll in a prescription drug coverage (Medicare Part D) plan.

While those who are eligible for Medicare can enroll in a Medicare Advantage or MediGap policy, there are differences on when you can join. Medicare Advantage policies allow an open enrollment period once per year. MediGap plans allow you to enroll anytime and are a convenient option to meet an unanticipated healthcare coverage need.

All Medicare Advantage plans have “service areas.” These are geographic areas where they offer coverage. Generally, you need to reside in a plan’s service area in order to join it. Because MediGap plans supplement your traditional Medicare coverage, you can still visit any doctor or stay in any facility that participates in the Medicare program.

So which plan should I pick?

That is based on your individual healthcare needs. The benefit of having so many options to select from is you are likely to find an option that fills your needs perfectly. However you could want help finding a perfect plan for you. Our insurance agents stand ready to help you sort through your Medicare options and help you in selecting a plan that allows you to meet your objectives. Contact Sun Coast Legacy Advisors today.

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