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Medicare Supplement vs Medicare Advantage

By February 22, 2023No Comments

If you are on Medicare or new to Medicare you may be wondering should I go with Medicare Advantage or Medicare Supplement? There are pros and cons to both and it can be a hard decision. There are a lot of factors to think about.

Medicare Supplements typically have a higher premium and do not include prescription drug coverage or extra benefits like dental and vision. The plus side with a supplement is it you typically have lower out of pocket expenses at the doctor or hospital vs an advantage plan. Not too mention you have the freedom to go to any doctor that accepts Medicare and don’t need to deal with a network since Original Medicare is the primary insurance. Another thing to take into consideration with Supplements is the rates. Some states the rates can go up as you age (attained age), some states the rates don’t change based on age (community rated) and some states the rate stays at the age rated when they were issued (issue age). The rates can and usually do go up no matter how they are rated when companies file for a rate increase. Also some state will accept and rate a supplement based on health if the state does not have guaranteed issue rights. Some policies may impose a waiting period if the person applying has had no prior coverage besides Medicare. Good questions to ask if considering getting an advantage plan rather than a supplement.

– What will the price difference be in premium if I wait?

– Can I qualify later and will there be waiting period?

– Is my state a guaranteed issue state or do they underwrite on health, sex, or smoking?

States like New York, Vermont, Massachussetts, and Connecticut are community rated and have guaranteed issue rights while others do not. It’s very important to understand your state’s and companies rules regarding Medicare Supplements when making this decision. 

 

Medicare Advantage is good and does work for many people. They tend to offer lower premiums than Supplements and usually include prescription drug coverage and other benefits like dental and vision all into one convenient plan. One drawback is they come with a network but if your doctors and hospitals participate or accept it they can work fine. Another drawback is they tend to have higher out of pocket expenses at the doctor or hospital than a Medicare Supplement might but all the money being saved on monthly premiums and extra benefits can make up for that. Good questions to ask when considering an advantage plan.

– Are my doctors and prescriptions covered? What are my copays and maximum out of pocket?

– Is it a PPO or HMO? When can i go outside the plans network and how much extra does it cost?

– What rules will apply to getting a Supplement down the road if I want one?

 

It’s best to consult with a local licensed professional to help discuss and compare your options further since every state and everyone’s situation is different and greatly effects options.