When you become eligible for Medicare, you would present two main options, A Medicare Supplement Plan or a Medicare Advantage Plan. As these two options can have a significant impact on one’s health coverage and finances, it’s crucial to carefully consider each plan’s pros and cons. In this essay, I will argue why a Medicare Supplement Plan is a better option than a Medicare Advantage Plan for those seeking maximum flexibility, broad provider choice, and predictable out-of-pocket costs.
First, the biggest advantage of Medicare Supplement Plans is their flexibility.
These plans operate in conjunction with original Medicare, which means beneficiaries can choose to receive healthcare services from any provider that accepts Medicare. In contrast, Medicare Advantage Plans commonly require beneficiaries to use in-network providers and may restrict access to specialty care or out-of-network providers.
For those someone who frequently travels or lives between multiple states, a Medicare Supplement Plan is an ideal option. With a supplement plan, one can receive coverage at any Medicare-approved doctor, hospital, or medical facility across the United States.
This is also true for those who move between states often or spend equal time in different states throughout the year. Since Medicare Supplement Plans do not have network restrictions like Advantage Plans, you’ll always have access to covered medical services regardless of where you’re located.
Secondly, those who choose Medicare Advantage Plans are oftentimes limited in their choice of providers.
In the case of an Advantage Plan, beneficiaries are restricted to a list of in-network providers. This can be problematic if someone’s current caregiver or medical specialist isn’t in the plan’s network. This could force them to switch healthcare providers, which can lead to disruption and anxiety for the patient.
Alternatively, Medicare Supplement Plans offer beneficiary relatively unrestricted access to healthcare providers. This means you get to choose the doctors, hospitals, and facilities you prefer, without concern for whether they are in-network or not. This can provide you with greater peace of mind when it comes to receiving the medical care you require.
Thirdly, Medicare Supplement Plans provide a more predictable and transparent plan for out-of-pocket costs than Medicare Advantage Plans.
Supplement Plans fill the part of your healthcare costs not covered by Original Medicare, making it easier to understand exactly what your healthcare costs will be. As someone under Medicare, there are no copays, coinsurance, or deductibles for many services such as preventative care, doctor and specialist visits, and ambulatory services.
In contrast, Medicare Advantage Plans have a set out of a pocket limit, which could be higher than anticipated.
For example, your out-of-pocket limit may only apply to in-network providers, and could be as high as $6,700 in 2020, which can be really affected by serious illness, or a hospital stay. Also, certain services like lab tests and chemotherapy may have coinsurance rates that require you to pay a percentage of the service cost, which can vary and be hard to predict.
Another important factor to consider when deciding between Medicare Supplement Plans and Medicare Advantage Plans is individual medical needs. Medicare Advantage Plans often tier their benefits and services, so preventive care and primary care visits have no out-of-pocket costs or may require a copay. Specialist visits, diagnostic tests, or hospitalization may have high out of pocket costs.
In contrast, Medicare Supplement Plans provide more comprehensive coverage, allowing you to choose a plan that will cover all or most of your healthcare needs. Medicare Supplement Plans offered by private insurers cover a set of essential benefits, which means you can anticipate and budget for the costs of your healthcare.
Lastly, Medicare Supplement Plans have no enrollment restrictions. There are no restrictions enrolling during your initial Medicare enrollment stage or during your initial Open Enrollment Period when you turn 65, as long as you keep paying your premiums each month. There could be enrollment restrictions when trying to replace or change your Medicare Supplement Plan in the future. You’ll keep your policy, regardless of your healthcare status or whether your health changes. This provides peace of mind when you need it most. Knowing these concerns about a change in coverage won’t distract from focusing on getting the medical support you need.
So why choose a Medicare Supplement Plan instead of a Medicare Advantage Plan?
For most beneficiaries, the flexibility of choice, comprehensive coverage, and predictable out-of-pocket costs provided by Medicare Supplement Plans. This provides greater peace of mind than the plan structures of Medicare Advantage Plans. Although cost options may vary, Supplement Plans offer a better overall value, substantial policyholder freedom and the peace of mind. This comes with knowing you won’t place money at risk due to unexpected healthcare costs.
For more information on Medicare Plans or if you just have a few questions, please give us a call at 215-967-8828
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare to get information on all your options.