• Peter Stoner


Medicare Advantage vs. Medicare Supplement... Which is Best for You?

I've assisted, or led the presentation of hundreds of Medicare Advantage and/or Medicare Supplement seminars. The presentations are regulated by CMS, the Centers for Medicare and Medicaid Services. Their strict oversight has been mandated by Congress to help assure that employees of Health Plans and/or brokers are accurate in describing their services. Ironically, the oversight adds a layer of "government or legal speak" that can be confusing to those who are not accustomed to it.

When the seminars end, there is a Q & A session so that everyone can clarify their understanding of what they heard. Inevitably, someone asks the question, "What's the difference between a Medicare Advantage and a Medicare Supplement plan?" Because the seminars deal directly with that question, it is always disappointing to hear it asked, but not surprising given that these things are complicated.

One of the big differences between the two types of plans is ACCESS TO DOCTORS. On a Medicare Supplement plan, you can go to any doctor who accepts Medicare. In Massachusetts, that's currently about 96% of all doctors. You can go to a specialist WITHOUT A REFERRAL, again as long as they accept Medicare. Access to doctors is especially important to those who have established relationships with a particular specialist, or want to be assured of access to certain doctors or hospitals, if they develop a chronic condition or disease. As Martha would say... that's a good thing.

However, Medicare Supplement plans are, typically, MORE EXPENSIVE than Medicare Advantage plans. Often a retiree on a fixed income may make a decision regarding the two types of plans based on the cost of their monthly premiums. The Medicare Advantage plan will, typically, have a contracted network of doctors and hospitals. Members of those plans pick a primary care doctor (PCP) from a list provided by the health plan. If the member requires the services of a specialist, they need to get a referral from their primary care doctor. That specialist will usually be in a "circle" of specialists that is part of the primary care doctors' "group". So, members in Medicare Advantage plans will usually pay a lower monthly premium and are required to select a primary care doctor and get referrals to specialists. Martha would also say that the lower premium is a good thing.

You might be asking... "That's all well and good, but what's the best type of plan for me?". Well, that depends. Ask yourself these questions to help you clarify matters:

  • Does my PCP accept any Medicare Advantage Plans?

  • If not, am I willing to change to another PCP?

  • Which specialists are in the referral circle of my PCP?

  • Can I afford the monthly premium of the Medicare Supplement?

  • What extra benefits can I get, if any?

  • Is the plan I am considering a not-for-profit, or a for-profit plan?

  • What is their ranking and reputation?

  • What does my doctor say about the plan I am considering?

  • What are the potential out of pocket costs associated with the plan?

  • Do I need to take a separate Part D plan (prescriptions), or can I get one that's included?

Part D is a subject for a future blog... Stay tuned!

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