When it comes to choosing the Medicare coverage that’s best for you, it’s important to understand the differences between these two options.

A Medicare Supplement insurance policy is not the same as a Medicare Advantage plan.A Medicare Supplement is an insurance policy designed to pay expenses approved by but not covered under Medicare Part A (hospital) and Part B (medical) including deductibles and coinsurance. Medicare was never intended to cover all hospital and medical expenses and purchasing a Medicare Supplement is one way to cover some or all of what basic Medicare does not provide.

When you have Medicare and a Medicare Supplement you can generally go to any doctor and any hospital in the United States as long as they accept Medicare. You don’t need referrals or permission from a primary care doctor to see specialists. These factors are important to people who want the freedom to choose their own doctors, and those who travel frequently or spend parts of the year away from their primary residence.

Key Points to a Medicare Supplement Policy

  • You must have original Medicare designated as your primary coverage in order to have a Medicare Supplement.  In other words Medicare must pay your bills first before they can be submitted to a Medicare Supplement.
  • There are ten “standard” Medicare Supplement designs identified by letters A through N. Each standard policy must include the same benefits regardless of the insurer.
  • Claims for benefits under a Medicare Supplement are processed electronically.  You make no payment at doctor visits or for other services.  You don’t need to submit claim forms. If there are any amounts due after your claims are processed you are billed by the provider.
  • Medicare Supplement policies are guaranteed renewable and the coverage does not change from year to year therefore they are not subject to the Medicare Annual Enrollment Period.
  • Medicare Supplement policies do not include prescription drug coverage.  In order to have coverage for prescription medication you will need to purchase a separate stand alone Medicare Part D plan or have coverage through the Veterans Administration or through PACE or PACENet, etc.

We can help you determine which company can offer you the lowest cost Medicare Supplement in Pennsylvania.  Call us at 1-800-649-9604.

A Medicare Advantage plan is not the same as a Medicare Supplement policy.Medicare Advantage plans replace the benefits provided under Medicare Part A (hospital) and Part B (medical). When you join a Medicare Advantage plan, they become your primary payer of hospital and doctor bills and other medical expenses. And although Medicare is not your primary insurance you must be enrolled in Medicare Part A and B in order to join a Medicare Advantage plan.

Medicare Advantage plans often have lower monthly premium costs than Medicare Supplements – some actually have $0 premium cost. Many plans include Part D coverage for prescription drugs. In addition some Advantage plans include benefits for dental, vision and hearing and fitness club membership.

Key Points to a Medicare Advantage Plan

  • Medicare Advantage plans generally require copayments in addition to your monthly premium for doctor visits and other medical care such as blood tests, x-rays, MRIs, hospitalization, etc.
  • Medicare Advantage plans can be established as an HMO, PPO or PFFS plan with a network of participating providers who have contracts with the insurance companies. Using non participating providers generally will cost you more than participating providers.
  • Insurance companies that offer Medicare Advantage plans usually have several plan design options, but they are not standardized like Medicare Supplements.
  • Medicare Advantage plan coverage and costs are guaranteed on a calendar year basis. The plans have strict enrollment guidelines and you can only enroll or disenroll during a qualified enrollment period such as the Medicare Annual Enrollment Period.

We can help you determine which Pennsylvania Medicare Advantage plan best meets your needs for coverage and cost.  Call us at 1-800-649-9604.

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