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You won’t need a Medicare Supplement (also known as Medigap) plan if you decide to enroll in a Medicare Advantage plan. It wouldn’t do you any good, since a Medicare Supplement plan wouldn’t cover your Medicare Advantage out-of-pocket costs (such as deductibles).
In fact, an insurance company cannot sell you a Medicare Supplement plan if the company knows that you have coverage from a Medicare Advantage plan, unless your coverage under the Medicare Advantage plan ends before the effective date of the Medicare Supplement plan. That is the law.
However, if you already have a Medicare Supplement plan, there’s nothing to stop you from enrolling in a Medicare Advantage plan. You will probably want to drop your Medicare Supplement plan when you get a Medicare Advantage plan. If you keep your Medicare Supplement plan, you must keep paying your Medicare Supplement plan premium, but your Medicare Supplement plan won’t work with your Medicare Advantage plan. That is, the Medicare Supplement plan will not pay any of the deductibles, coinsurance, copayments or premium (if any) of your Medicare Advantage plan.
What are Medicare Advantage plans?
The Medicare Advantage (Medicare Part C) program gives you an alternative way to receive your Medicare Part A (hospital insurance) and Part B (medical insurance) benefits. The exception is hospice care, which continues to be covered by Part A.
Offered by private insurance companies contracted with Medicare, Medicare Advantage plans often include additional coverage, such as prescription drug coverage and routine dental services. All Medicare Advantage plans must limit your maximum out-of-pocket expenses to a specified amount that Medicare sets manually. The government-sponsored Medicare program does not have this protection.
Some Medicare Advantage plans (called Medicare Special Needs Plans) are designed to help people with special health-care needs, such as diabetes or congestive heart disease.
Deductibles, copayments and coinsurance amounts vary among Medicare Advantage plans. Medicare Advantage plan premiums vary as well, and some insurance companies may offer $0 premium Medicare Advantage plans. However, you will still have to pay your Medicare Part B premium if you sign up for a Medicare Advantage plan.
You might have to use the Medicare Advantage plan’s network of participating providers to receive the full benefits of the plan. You have to reside in the plan’s service area.
What are Medicare Supplement plans?
Medicare Supplement plans are also offered by private insurance companies, and can help you pay out-of-pocket costs for services covered under Medicare Part A and Part B. Different Medicare Supplement plans pay for different portions of those costs, such as copayments, coinsurance, and deductibles. Medicare Supplement plan benefits are standardized across most of the country. (Massachusetts, Minnesota, and Wisconsin each standardize Medicare Supplement plans differently.)
Some Medicare Supplement plans may extend coverage to emergency care you receive while traveling outside the United States (80% of approved costs up to plan limits), or to doctors’ charges that exceed Medicare’s approved amount (Part B “excess charges”).
Most Medicare Supplement plans let you visit any doctor who accepts Medicare assignment. There’s one type of Medicare Supplement plan, called a Medicare SELECT plan, that might require you to use providers in the plan network.
When might you be able to switch between Medicare Advantage and Medicare Supplement?
You may wonder why you can’t enroll in a Medicare Supplement plan if you have already enrolled in a Medicare Advantage plan. The answer is simply that Medicare Supplement plans are designed to work alongside the federal government-sponsored program, Medicare Part A and Medicare Part B, not with Medicare Advantage plans.
Nonetheless, if you had a Medicare Supplement plan before you enrolled in a Medicare Advantage plan, you won’t be forced to cancel your Medicare Supplement plan. Why? If you drop your Medicare Supplement plan, you might not be able to get it back.
There are a few exceptions to this rule. You may have special rights to purchase a new Medicare Supplement plan. For example, if you move out of your Medicare Advantage plan’s service area, or your plan stops serving your area, you generally have a “guaranteed-issue right” to buy a Medicare Supplement plan within a certain limited time period.
Another example of guaranteed-issue rights is called a “trial right.” Suppose you had a Medicare Supplement policy that you dropped to enroll in a Medicare Advantage plan for the first time, or to purchase a Medicare SELECT policy for the first time. If you decide to leave your Medicare Advantage plan or Medicare SELECT policy within the first 12 months of enrollment and return to the federally-sponsored Medicare Part A and Part B, you may be able to get back your Medicare Supplement plan if it is still available or sign-up for a new Medicare Supplement plan.
In situations such as these, your new Medicare Supplement plan won’t include prescription drug coverage—even if you had this coverage in your former Medicare Supplement plan (plans sold today don’t include prescription drug coverage). You may be able to enroll in a stand-alone Medicare Prescription Drug Plan if you leave your Medicare Advantage plan during the first year you have it.
Remember, if you keep your Medicare Supplement plan when you enroll in a Medicare Advantage plan, you’ll still have to pay your Medicare Supplement plan premium, your Part B premium, and your Medicare Advantage plan premium (if any). If you decide to add Medicare prescription drug coverage, you may have a separate premium for this as well. You may want to consider carefully whether the benefits of retaining the Medicare Supplement plan outweigh the cost.
To learn more about these types of Medicare insurance and the options available where you live, I invite you to contact me. To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
The product and service descriptions, if any, provided on these Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the Federal Medicare program.