Additional Services

Part 3 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 3: Coverage

What does each type of plan cover? A Medicare Supplement will pay if Original Medicare pays, but if Original Medicare doesn’t pay the Supplement won’t pay. The Supplement company has no decision-making power with regards to what is covered and what isn’t. Remember when you have a Supplement, Original Medicare is primary so what they say goes. A Medicare Advantage Plan “must cover all of the services that Original Medicare covers”. You can follow a link to the source of this definition by clicking here. If Original Medicare covers cataract surgery then a Medicare Advantage Plan must cover cataract surgery. If Original Medicare covers a knee replacement, then a Medicare Advantage Plan must cover a knee replacement Etc., Etc. Medicare Advantage Plans can offer additional benefits such as vision, dental, hearing, transportation, and over the counter benefits.

John’s Take

Aside from the extras (vision, dental, hearing) that might come with a Medicare Advantage Plan you are covered for the same medically necessary services with both plans. Remember the word covered doesn’t mean there are no out of pocket costs. This is where the debate tends to come in. If you have a hip replacement with a Plan F Medicare Supplement you will have no out of pockets costs. If you have a hip replacement with a Medicare Advantage Plan you will most likely have a copayment for your hospital stay and could have additional copays for rehabilitation. These copays don’t mean your hip replacement isn’t covered it’s just that your coverage includes cost share. Remember “pay me now versus pay me later”?

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.