Those who are Medicare age or close often have questions about the difference between traditional Medicare with a supplement (often called Medigap), and Medicare Advantage.
Medicare Advantage, or Medicare Part C, is a bundled plan that private companies administer. The plans vary based on which medical services are available in a certain area, and people typically need to receive treatment from an approved network of healthcare professionals. Medicare Advantage plans may offer additional benefits, such as dental care or vision care.
Traditional Medicare is available in several parts that cover in-hospital treatments, medical care, and prescription drugs. However, out-of-pocket costs usually include deductibles and coinsurance. Medicare supplement plans, or Medigap plans, are available to help people fund these extra costs. People can enroll in them alongside traditional Medicare. Traditional Medicare with a supplement usually has fewer restrictions on what providers can be seen under the plan.
A person can’t be in Medicare Advantage and have a supplement plan.
When a person qualifies for Medicare at the age of 65 years and enrolls in Medicare Part B, they have a 6-month Medigap open enrollment period (OEP). During this time, an insurance company cannot deny a person Medigap coverage based on their age or any preexisting health conditions they have.
However, after this enrollment period ends, an insurance company does not have to sell a person a Medigap policy, and they may also charge more for a policy. For this reason, people may find that they can save money if they sign up for Medigap within the first 6 months of their Medicare benefits starting.
This also may make it more difficult for a person who decides Medicare Advantage isn’t working well for them to switch to traditional Medicare with a supplement.
If someone begins Original Medicare with a Supplement and decides to change to a Medicare Advantage Plan, they have 12 months to return to Original Medicare and still be able to get their original Supplement back. After 12 months, they would need to be health screened and could be denied. In turn, if someone starts with Medicare Advantage and wants to get a supplement, they have 12 months to also get a supplement with no underwriting. The 6-month window would apply to a beneficiary getting a Medigap the first time.
“If you have been on an Advantage plan and then switch to traditional Medicare, your chances may be less of getting covered by a supplemental plan. Supplement companies can deny coverage based on health status, age, and preexisting conditions,” said Kim Shadduck, business office manager at JCH&L.
When choosing a plan it’s important to look to the future, Shadduck said.
“Those looking at Medicare options need to consider not only their current health, but their future health. Look at family risk factors and possible future diagnoses, and consider what you may need in the future,” she said.
Those who need help considering possible plans can contact Nebraska SHIP at 1-800-234-7119. Nebraska SHIP educates people about Medicare and empowers them to make informed decisions about health insurance. SHIP does not sell insurance nor endorse any insurance company, product or agent.
Those with questions may also call Jefferson Community Health & Life.
“While we can’t tell you which plan is best for you, we can help you consider things to think about in selecting a plan,” Shadduck said. “Our goal is to provide our area residents with the highest quality health care, and to help answer their questions about insurance and financial assistance for health care.”