Medicare Advantage vs. Other Medicare Plans

It can be confusing to understand all your Medicare options. When you hear someone talk about Medicare Parts A and B, this refers to Original Medicare. Part A is your hospital coverage and Part B is your medical coverage. Together, Parts A and B, or Original Medicare, covers approximately 80% of medical and hospital costs. If Original Medicare only covers 80% of your medical expenses, how do you pay for the other 20%? That’s where Medicare Insurance plans come in.

Medicare Supplement Plans

A Medicare Supplement (sometimes called a Medigap) plan helps to cover the other 20% of your medical expenses. Medicare Supplement plans do not help pay for the cost of prescription drugs, so in addition to this plan, you would also want to get a separate Part D (Prescription Drug) plan.

The benefits of having a Medicare Supplement plan is that members can go to any doctor of their choice regardless of network, and members can see specialists without having to get a referral from their primary care doctor. Medicare Supplement plans also make it easy to travel and receive medical attention because members are not restricted to medical network groups.

Medicare members who have a Medicare Supplement plan will want to get a separate prescription drug plan to cover the cost of their medications. You do not need to use the same insurance company for both of these plans, and you can change your prescription drug plan every year during Medicare’s Annual Enrollment Period (AEP), which runs October 15 to December 7.

Medicare Advantage Plans

Medicare Advantage plans (MAPD) also help cover the 20% of medical costs for Medicare members. However, unlike Medicare Supplement plans, MAPD plans are a supplement + a prescription drug plan, so members on this type of plan don’t need to get a separate drug plan. Think of MAPD plans as Medicare Parts A, B, and D all in one.

Depending on where you live in the United States, MAPD plans can be HMO or PPO. If an MAPD plan is an HMO, members are required to have a primary care doctor, and before seeing any specialists, members have to get a referral from their primary care doctor. Also, on HMO MAPD Plans, members may find they can only see doctors within a single network, so specialists in another network won’t be covered. Sometimes, insurance companies have a PPO MAPD plan, which still acts as a traditional MAPD plan, but members aren’t limited to a single primary care doctor.

When you are considering which type of Medicare insurance plan is best for you, consider:

  • Your current medical health.
  • What medications you take.
  • How often you see a doctor.
  • Your medical history and any possible medical conditions that may occur as you age.
  • What doctors and medical groups are available in your area.
  • How much the premiums and copayments are for each type of plan in your area.

Have questions? We can help!

Caress Insurance Agency, LLC. has agents in San Diego County and can help answer your Medicare questions and provide you with the latest information on your Medicare Insurance Plans.  Get in contact by visiting their page and submitting your information.

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