Questions & Answers (FAQ)

• Medicare Supplements are also called Medigap insurance and work together with your original Medicare – that is, filling the “gaps” in your Medicare Part A (in-patient or hospital insurance) and Medicare Part B (our-patient or physician insurance) coverage.
  
  
• Medicare Advantage Plans work in place of your original Medicare A and B, often adding additional benefits like vision, dental, or wellness programs.
  
  
• Medicare Supplements are standardized across the country (Plans E, H, I, or J still exist, but are no longer available to new beneficiaries) .  (Example: If your friend has a Medicare Supplement Plan C in Ohio and you have Plan C in Florida - they provide the same Medicare Supplement coverage, although you may pay a different monthly premium for your Medicare Supplement as compared to your friend in Ohio.)
  
  
• Medicare Advantage plans are not standardized and can vary from company to company and county to county.  (Example: If your friend has a Medicare Advantage Plan from Company AAA in Summit County, Ohio and you have Medicare Advantage Plan from Company BBB in Portage County, Ohio - they probably do not provide the same coverage - and you most likely pay a different monthly premium.)
  
  
• Medicare Advantage plan benefits are also often presented in terms of co-payments ($XX per night in the hospital) as compared to co-insurance (15% of the cost per night in hospital).  Medicare Supplements typically pay the balance beyond Medicare Part A and Part B coverage.
  
  
• Medicare Supplement coverage usually costs several hundred dollars per month  whereas Medicare Advantage Plans may cost from $0 - up to several hundred dollars per month.  Some Medicare Advantage Plans actually pay you back a portion of your Medicare Part B premium to join their Plans (though this is now relatively rare).
  
  
• Medicare Advantage Plans can include your Medicare Part D prescription drug coverage (also called MA-PDs).
  
  
• Medicare Supplements available after 2006 do not offer prescription drug coverage and you will need to join a stand-alone Medicare Part D prescription drug plan to get these benefits.  Some Medicare Supplement Plans providing prescription coverage still exist, but they are no longer available for new beneficiaries. (Medigap policies H, I, and J provided limited prescription drug coverage from 1992-2005 and people enrolled in these plans may continue to use them.)
  
  
• You can join a Medicare Advantage Plan without any medical underwriting or medicare exam - but you cannot have End Stage Renal Disease (ESRD).  Medicare Advantage Plans are guaranteed issue.  However, Medicare Advantage Special Needs Plans may have other health or financial restrictions depending on the plan.
  
  
• If you did not join a Medicare Supplement when you first became eligible for Medicare (up to 6 months after Medicare eligibility - over 65 and enrolled in Medicare B), you will be subject to medical underwriting and will pay a higher monthly premium for your Medicare Supplement if you have any pre-existing health conditions - or you can be denied coverage entirely.
  
  
• Medicare Advantage Plans and modern Medicare Supplements (issued after 1992) are  guaranteed renewable - no matter what changes in your health.
  
  
• Medicare Supplement monthly premiums can change every year or twice a year and vary by state (subject to State Insurance Commission approval).  Medicare Advantage Plan monthly premiums and coverage benefits can change once a year and vary by county (subject to Federal Medicare guidelines and approval).

• Medicare Supplements usually allow you to choose your own doctors and hospitals.  Medicare Advantage plans most often have a fixed health care network of doctors and hospitals.  If you have a Medicare Advantage plan with a health care network, you may pay a higher cost to visit a doctor or hospital outside of the network - or you may need to pay the entire cost yourself.

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