Medicare Supplement vs. Medicare Advantage Plans?

Should you choose Medicare Supplement or Medicare Advantage?

While Original Medicare offers most people good basic health coverage, it only pays 80% of approved costs concerning doctors, hospitals, and medical procedures. It also typically doesn’t cover the cost of prescription drugs or dental care. As a result, many people enroll in a supplemental insurance plan to help cover the gap. 

Medicare Supplement (Medigap) and Medicare Advantage (Part C) plans offer different benefits. Unfortunately, it’s not possible to enroll in both, so you’ll need to decide what plan best suits your needs. Both options are available to anyone eligible for Medicare. You’ll need to consider your health, budget, and how you’ll use your plan to determine which one is right for you. If you want help weighing your options and live in North Carolina, our experienced and knowledgeable team of Medicare agents NC can help.

Why do I need additional Medicare coverage options?

Original Medicare comprises Part A (hospital coverage) and Part B (doctor and outpatient services), which covers about 80% of medical costs. Because of this, additional coverage is recommended, and you’ll also need to add a Part D prescription drug plan. Medicare Advantage Plans are one alternative to Original Medicare and usually include Part D as standard.

While many people are satisfied with Original Medicare, it is essential to consider your options. For example, suppose you don’t choose to get Medicare Part D (drug coverage) or Medigap when you first become eligible for Medicare. You may have to pay more for this type of coverage if you need it later. This could mean paying a lifetime premium penalty to get your Medicare drug coverage.

What are Medicare Supplement Insurance Plans?

These plans complement Original Medicare Parts A and B. They are designed to help cover out-of-pocket expenses for Medicare Part A and Part B gaps. Medicare supplement plans are identified by letters, offering a menu of benefits that you can choose from that best meet your needs. Depending on what you choose, you may receive coverage for:

  • Copayments
  • Deductibles
  • Coinsurance
  • Other benefits

In addition, a Part D stand-alone prescription drug plan is needed.

What about Medicare Advantage Plans?

Medicare Advantage Plans (also known as Part C) are another way to cover any gaps from your Medicare Part A and Part B coverage. These types of plans are Medicare-approved and offered by private companies. They must comply with rules set by Medicare, and plans include additional benefits and features beyond what you can expect within Original Medicare.  

In many cases, you will be required to use doctors in the plan’s network to access these benefits. Some plans also offer additional options, for example, Medicare Advantage plans with dental and vision benefits. While there are limitations in coverage and certain imposed out of pocket limits, most Medicare Advantage plans offer:

  • Prescription coverage
  • Copayments for doctor visits
  • Vision and dental coverage
  • Fitness programs
  • A range of other benefits for you to choose from

How do I compare the two options?

When comparing the options, consider the following criteria to help determine what best suits your needs. If you already have Medicare Advantage, it’s also important to consider your Medicare Advantage open enrollment period. If you want to make any changes or switch back to Original Medicare, you can do so within this period. 

Consider searching for Medicare supplement agents near me to find a local specialist. If you’re based in North Carolina, get in touch with one of our Medicare supplement agents in Charlotte or other locations throughout the state.

Medicare
Supplement
Medicare
Advantage
Doctors and hospitalsYou have the option of selecting your own doctors
and hospitals that accept Medicare
patients.
You may have network limitations, meaning you can’t choose your preferred doctor or hospital.
ReferralsYou are able to see a specialist without a referral.A referral may be required from your local MD.
Prescription CoverageYou will need to enroll in a standalone Part D plan to access drug coverage.Prescription coverage is usually included as standard.
PremiumYou will pay a monthly plan premium in addition to your Part B premium.
When you use services, you will
have low or no copays and coinsurance depending on the plan selected.
You will pay a low or $0 monthly
premium in additional to your Part B
premium. When you use services
your copays, coinsurance and
deductibles go towards a set
out-of-pocket limit.
TravelCoverage goes with you across state lines, so if you leave North Carolina you’re covered. Depending on the plan, you may also have coverage when traveling abroad.Due to network limitations, non-
emergency services may be limited.
Emergency care is generally covered.
EnrollmentYou can apply at any time after you turn 65. However, it’s best to do so during your initial enrollment period in order to receive guaranteed issue.

There are specific periods during the year you can enroll and/or switch plans. Generally, you can’t be denied
coverage or charged more based on your health status.

Quick Reference: Medicare Supplement vs. Medicare Advantage

What else to consider?

North Carolina’s Medicare Advantage rate of participation aligns with national averages across the U.S. In 2019, the national number of Medicare enrollees who had Medicare Advantage plans was 37%, while 63% had Original Medicare plans. In addition, a recent  AHIP analysis identified that about 40% of North Carolina’s Original Medicare beneficiaries are enrolled in a Medicare Supplement plan. These figures highlight that both plans have their benefits, depending on your individual needs.

When deciding on the right plan for your needs, it’s good to consider all of your options. This might include the cost of the plan, the doctors you can see on your plan, the convenience and access to medical treatment available, your travel plans, current health, and your lifestyle. 

Undertaking a thorough assessment can help determine the right level of coverage for you. If you need help finding the best Medicare supplement plans in North Carolina, then get in touch with our Medicare Advantage agents today. We can provide advice on the different medical supplemental plans in North Carolina that best meet your requirements.

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