Medicare Underwriting - Advantage vs. Supplement - Happy Seniors

Medicare Advantage vs Medicare Supplement

Compare Advantage Vs Medicare Supplement

The Medicare 2021 chart below compares Medicare Advantage vs Medicare Supplement. This chart shows positive (green), negative (red), and equal value (black). Medicare Supplement works with Original Medicare, so it provides you with nationwide coverage and access to any doctor and hospital without referrals.

However, Medicare Advantage provides you with local (HMO) or regional (PPO) coverage for doctors and hospitals in-network. For example, doctors outside an HMO network are not covered and require referrals. Furthermore, doctors outside of a PPO network are allowed but will cost you more. The 2021 chart below shows you several differences between Medicare Advantage vs Medicare Supplement.

Medicare Advantage vs Medicare Supplement - happy seniors
Medicare 2021 Chart - Advantage vs Supplement infographic
Embed and download Medicare Advantage vs Medicare Supplement Infographic

MedicareBob Video

In this MedicareBob video, Robert Bache “talks about the most important decision” people new to Medicare will make. Should you choose a Medicare Advantage or Medicare Supplement? Watch this video to help determine the right Medicare plan for you. 

Medicare Advantage vs Supplement Cost Differences

Part B Premium

Medicare Advantage and Medicare Supplement require you to have Medicare Part B. There is no Medigap Plan that pays your Medicare Part B premium. However, some Medicare Advantage Plans pay all or part of your Part B premium.

Copays and Coinsurance

Medicare Advantage charges you copays for each doctor visit or medical service. However, Advantage Plans do not charge you coinsurance.

Medicare Supplement Plans have no copays, except plans K (50%), L (75%), and N. You are charged copays for diagnostic tests, hospital outpatient, and ER visits. For Plan N, you pay up to $50 for outpatient emergency room visits and up to $20 for outpatient doctor visits.

Furthermore, Supplement Plans K and L only pay 50% and 75% respectively for Part B, Part A Hospice, and Skilled Nursing Facility coinsurance. In other words, you pay the remaining balance. For example, Medigap Plan K will cover 50% of your outpatient medicare service.

Advantage vs Supplement Plan Premiums

Medicare Advantage Plan premiums will vary based on coverage and the insurance carrier. However, CMS.gov reports, “historically low premiums in Medicare Advantage.” Furthermore, you have more than 1,600 prescription drug plans from which to choose. We can help you find the right Medicare Advantage Plan with our Advantage Plan Finder.

Medicare Supplements pay Part A and Part B coinsurance. For example, Medigap Plan G covers 100% of your hospital and medical services after you pay a $198 Part B deductible. Plan G is the most comprehensive coverage available for people new to Medicare in 2020. You can shop Medigap Plans by calling Senior Healthcare Direct at 1-855-368-4717 or get your quote.

Medical Underwriting – Advantage vs Supplement

Medicare Underwriting - Advantage vs. Supplement - Happy Seniors
Happy seniors avoid medical underwriting.

Starting in 2021, Medicare Advantage Plans accept all health conditions, including End-Stage Renal Disease (ESRD). Likewise, you can enroll in Medicare Supplement Plan without medical underwriting during your initial Open Enrollment Period (OEP). In other words, there is no medical underwriting when you are first eligible for Medicare, which includes:

  • Three months before you turn 65
  • The month you turn 65
  • Three months after you turn 65

However, anytime after your initial Open Enrollment Period, medical underwriting is required. For example, you switch to a different Medigap Plan after your initial OEP. Discover some of the most common underwriting questions and find out whether or not you can qualify.

Prescription Drugs – Advantage vs Supplement

Medicare Advantage Plans such as HMO and PPO most often include prescription drug coverage. However, Advantage Plans are not required to cover prescription drugs. If your HMO or PPO does not provide drug coverage and you enroll in a separate Medicare Prescription Drug Plan, you will be disenrolled from your Medicare Advantage Plan.

Medicare Supplement Plans fills in the coinsurance and deductible coverage gaps of Original Medicare, which does not cover prescription drugs. To get drug coverage, you need to enroll in a separate Part D drug plan. Senior Healthcare Direct can help you find the right drug plan that includes all your prescriptions.

Max Out-of-Pocket Limits – Advantage vs Supplement

Forbes reports Medicare Advantage maximum out-of-pocket (MOOP) limits will increase to $7,550 in 2021. In other words, your max out-of-pocket cost will be $850 more for in-network services in 2021. Once you reach this MOOP limit, your Medicare Advantage plan will cover all costs until the end of the year.

All Medicare Supplement Plans cover most or all of your out-of-pocket costs except plans K and L. Thus, CMS.gov put the following out-of-pocket 2021 limits on plans K and L.

  • $6,220 for Plan K ($740 increase from 2020)
  • $3,110 for Plan L ($170 increase from 2020)