Medicare Advantage Plans

Part 1 of 3: Should I purchase a Medicare Advantage plan or Medicare Supplement?

In my business, this is obviously the most often asked question I receive. This will be the type of coverage you have for the rest of your life barring some exceptions. My goal is to take a consultative approach with my clients so I prefer to educate and leave the decision making up to them.

This will be a 3-part series that includes:

  1. Access to Providers
  2. Cost
  3. Coverage

Part 1: Access to Providers

This might be the easiest part to understand. When you have a Medicare supplement you are free to see any provider that accepts Medicare. It’s that simple. It doesn’t matter if your supplement is from Mutual of Omaha, United Healthcare, Manhattan Life, Humana, etc. what matters is that with a standardized Supplement Original Medicare is your primary insurance. You don’t have to ask the provider “do you accept Mutual of Omaha?”, the only thing you need to ask the provider is “do you accept Original Medicare?”.

Things are not so simple when it comes to a Medicare Advantage plan. With an Advantage plan, not only must the provider accept Original Medicare, but the provider usually must be part of the insurance company’s Medicare network. For instance, with most HMO’s (Health Maintenance Organization) you are limited to seeing in-network providers and usually must get a referral from your primary care physician to see a specialist. With a PPO (Preferred Provider Organization) you can see providers in the insurance company’s network for a discounted price while generally seeing providers outside of the network for a higher cost. The final type of Medicare Advantage Plan is known as a PFFS (Private Fee for Service). Typically, PFFS plans do not have networks, but the provider must be willing to accept the payments terms and conditions of the plan.

John’s Take

Having Original Medicare and a supplement is going to offer you the most freedom with regards to seeing providers. With that being said many of the Medicare Advantage Plans have wide ranging networks that still allow you to see the providers you wish to see.

While these topics certainly aren’t all the questions that come up when comparing Supplements versus Advantage Plans hopefully this article will give you a good basis for understanding some of the differences.

Our priority is to educate our clients in a way that empowers them to make their own decision regardless of product choice.