Medicare Supplement vs. Medicare Advantage
Published: 05.13.2024
While Original Medicare (Part A and Part B) covers many health-care expenses, it doesn’t cover everything.
Even with covered health-cares services, beneficiaries are still responsible for a number of copayments and deductibles, which can easily add up. Additionally, Medicare Part A and Part B do not offer popular supplemental benefits, such as routine vision and dental, prescription drugs, or overseas emergency health coverage. If your client only has Original Medicare, they will need to pay for these costs out-of-pocket.
As a result, many people with Medicare enroll in two types of plans to cover these gaps in coverage. One option, called Medicare Advantage, is an alternative way to get Original Medicare. The other option, Medicare Supplement (or Medigap), works alongside Original Medicare coverage.
These plans are significantly different when it comes to costs, benefits, and how they work. It’s important your clients understand these differences as they review their Medicare coverage options.
The chart below highlights some of the key differences between the two options.
| Medicare Advantage | Medicare Supplement | |
|---|---|---|
| Can make changes during | Two open enrollment periods per year *unless eligible for a Special Enrollment Period (SEP) |
One period per lifetime unless there are special circumstances |
| Monthly premium | As low as $0 | Has a monthly premium (i.e., $95-$395 average based on carrier, age, gender, state, etc.) |
| Part B deductible | Does not have a Part B deductible *some plans may have health/drug deductibles |
Must pay unless you obtained Plan C or F before January 1, 2020 |
| Part B premium | Must pay | Must pay |
| Part B Give Back Offer | Offered by several popular plans (e.g., Humana, IBC, etc.) | No plans |
| Prescription drugs | Generally, includes Prescription Drug coverage | Does not cover (should purchase a Stand-Alone Prescription Drug Plan) |
| Routine dental, hearing and vision | Typically covered by most carriers | Does not cover |
| Networks that restrict providers | Yes, however most PPO plans have a broader network | No (providers must accept Medicare) |
| Standardized benefits | No standardization, which allows carriers to offer above and beyond traditional Medicare benefits (e.g., Silver Sneakers, OTC allowances, and transportation) | Yes (same benefits per plan letter) |
| Copayments and coinsurance | Usually has copayments and coinsurance, but includes a maximum out-of-pocket limit to protect beneficiaries | May cover all copayments and coinsurance |
