Medicare Advantage vs. Medicare Supplement

Health

Medicare is made up of four parts: A, B, C, and D. Parts A and B are Original Medicare and they cover long term or hospital care and doctor visits, tests, preventative care, or medical equipment, respectively. Part D refers to prescription coverage and is often included in Medicare Advantage.

Part C is Medicare Advantage; it consists of insurance coverage offered by private companies. Medicare Supplement, also called Medigap, is also a variety of plans offered by private insurances with the intention of covering costs that Original Medicare may not cover. Here’s a look at what is offered by Medicare Advantage and Medicare Supplement.

What is Medicare Advantage?

Medicare Part D, or Medicare Advantage, is insurance plans through private insurers that offer more things than Original Medicare or Medigap plans do. With the exception of hospice care, Advantage Plans can provide vision, dental, hearing, or Medicaid Part D (prescription drug coverage).

If you choose to begin an Advantage plan, you will continue to pay your Part B Premium (Part A has no premium for older Americans who have worked for at least 10 years or forty quarters). The new plan may have no additional premium or may be anywhere from $10-$100 extra dollars a month. It can be worth it to have lower deductibles or more complete coverage, particularly if your primary care providers are in the Advantage plan’s network. While almost all older Americans qualify for Medicaid, those with end-stage renal disease generally do not qualify for Advantage plans.

What is Medicare Supplement?

Medicare Supplement, or MediGap, can be more cost effective than Original Medicare in terms of deductibles, premiums, or copays, according to the Medicaid website. Instead of providing additional coverage, it provides a more thorough coverage of the same things as Original Medicare.

47 states offer standardized plans (Massachusetts, Minnesota, and Wisconsin have their own programs). The plans may come from different companies and have different premium costs, but they are all categorized by letters A-Z, so no matter where you are shopping for a MediGap plan, you will find the same coverage. For example, while you might pay $200 a month for plan A from Company #1 and have a $25 copay, but you might pay $210 from Company #2 and have a $20 copay.

An important thing to note: none of the MediGap plans provide dental coverage because Original Medicare specifically states that dental care not related to hospitalization is not included. Additionally, Part D is not covered under MediGap, so it is important to find a stand alone Part D Plan to cover medication expenses.

What’s the Difference?

The biggest difference between Advantage and Supplement is that Supplement does not offer coverage not already included in Medicare. For example, the only kind of dental coverage offered by Original Medicare is that required in hospital. If you needed to have a tooth extracted to prepare for jaw radiation, that would be covered, but they would not help with a tooth extraction needed for purely the tooth’s sake.

The difference in the two can be especially confusing because Medicare Advantage is itself a supplemental plan. However, it can provide conspicuously absent coverage that Original Medicare does not provide. Many Advantage plans offer vision, hearing, and/or dental coverage, although dental coverage for seniors is generally woefully lacking, particularly if you’re on a budget.

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