I get asked about this all the time. Many people think that their Medicare Advantage plan is a Medicare supplement. There are major differences between the 2 programs.
A Medicare supplement (Medigap) picks up the 20% that original Medicare does not cover you for. With this type of coverage there are no network restrictions. You can see any doctor in the country or U.S. territories that accepts Medicare. You do not need referrals either.
This type of plan charges a monthly premium over and above your part B premium. Most people also pick up a stand alone prescription drug plan (part D) with this type of coverage, for an additional premium.
Medicare Advantage Plans are health plan options funded by Medicare but administered by a private company. In other words, Medicare pays a private company, of your choice, a premium and that private company takes over and administers your Medicare.
Medicare Advantage Plans(MAPD) are popular options because they have little or no premium (especially in Florida), have affordable and predictable co pays , and these plans are loaded with many extra benefits that you do not receive with original Medicare. It’s common in a MAPD plan to receive preventative dental, vision and hearing benefits, part D prescription drug coverage, complimentary membership to fitness facilities in your area, OTC medicines and supplies, etc…. Some plans might even reimburse you up $99.90 per month to offset your Part B premium.
The major restriction with MAPD plans is they are “network” driven. Meaning if you select an HMO, you typically have to use their network of doctors and facilities, unless it’s an emergency or urgent care situation (In that case there are no restrictions) In most cases you will also need referrals to see specialists.
There are different kinds of MAPD plans and each plan determines how you receive coverage.
You need to make sure your Doctor’s and facilities are “in-network” or be willing to change your providers. It’s important top know this upo front. You do not want any surprises!
If you would like to ask me questions about what would be the best fit for you or your family member, do not hesitate to call or email.
“Medicare” Dave Silver
(813)417-2716 or (941)907-2879