Before selecting a plan, it’s important to understand the differences between your options, especially when it comes to Medicare Supplement Insurance Plans and Medicare Advantage Plans. Many people mistakenly sign up for Medicare Advantage Plans thinking they are the same as Medicare Supplement Insurance Plans—but they are not.
A Medicare Supplement Insurance Plan is used with original Medicare. Any caregiver that accepts Medicare will take a Medicare Supplement Insurance Plan because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Medicare Supplement Insurance Plans do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP. (there are exceptions to this) A Medicare Supplement Insurance Plan does not change year to year (although the cost does generally go up the coverage does not change).
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).
Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
A Medicare Supplement Insurance Plan works alongside Original Medicare. Any healthcare provider that accepts Medicare will also accept a Medicare Supplement plan because they only need to bill Medicare directly. Medicare covers its portion (usually 80% of Medicare-approved services), and the Supplement plan covers the remaining balance (typically 20%).
It’s important to note that Medicare Supplement Insurance Plans do not include Prescription Drug Coverage (Part D, PDP). If you don’t enroll in a PDP when you first become eligible, you may face a penalty when you sign up later (though there are exceptions). Unlike Medicare Advantage plans, a Medicare Supplement Insurance Plan’s coverage remains consistent year to year, though premiums may increase over time.
Medicare Advantage Plans, also known as “Part C” or “MA Plans,” offer an “all-in-one” alternative to Original Medicare. These plans are provided by private companies approved by Medicare. If you enroll in a Medicare Advantage Plan, you still have Medicare coverage. These “bundled” plans typically include Medicare Part A (Hospital Insurance), Part B (Medical Insurance), and often include Medicare Part D (Prescription Drug Coverage) as well.
Medicare Prescription Drug Plans (Part D), also known as “PDPs,” provide prescription drug coverage for those with Original Medicare, certain Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Each Medicare Prescription Drug Plan has its own list of covered medications, known as a formulary. Many drug plans organize their formularies into “tiers,” with each tier reflecting a different cost for the medications.
Drugs in lower tiers usually have a lower cost than those in higher tiers. If your medication is in a higher tier but your doctor believes it is the best option for you, you or your doctor can request an exception from your plan to receive a lower copayment for a similar drug in a lower tier.
We do not offer every plan available in your area. Currently, we represent 8 organizations which offer 75 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. This is a proprietary website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at www.medicare.com
We do not offer every plan available in your area. Currently, we represent 8 organizations which offer 75 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. This is a proprietary website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at www.medicare.com
