Medicare rules do not allow beneficiaries to have both a Medicare Advantage plan and Medicare Supplement Insurance. They are incompatible, and you’ll need to choose one or the other.
In this article, we’ll help you understand both types of coverage so you can make the best choice for you and your personal situation.
What Is Medicare Supplement Insurance?
When Original Medicare was created, it had two parts, A and B. Part A is hospital coverage, while Part B covers medical care. And, from its inception, Original Medicare was only designed to cover about 80% of a beneficiary’s major medical costs.
At the same time the Medicare system was created, the government created a private insurance system called Medigap, also known as Medicare Supplement Insurance. It allows private insurance companies to sell standardized policies that cover the 20% share of costs that Medicare does not pay.
Medicare Supplement Insurance plans are standardized. In all but three states (Massachusetts, Wisconsin, and Minnesota) there are 10 plans identified by the letters A, B, C, D, F, G, K, l, M, and N. Each policy with the same letter covers the exact same benefits.
Generally speaking, all Medicare Supplements cover:
- Inpatient hospital costs for up to a year after your Medicare Part A coverage runs out.
- At least 50% of the Medicare Part B coinsurance for doctor visits and other medical services.
- At least 50% of all hospice care coinsurance and/or copays.
You can see a complete list of what each plan covers with this Medicare Supplement Coverage Chart:
As you can see, Medicare Supplement Insurance plans cover costs associated with Medicare Part A and Part B. With the exception of foreign travel emergencies, plans do not cover any additional benefits. This is what distinguished these plans from Medicare Advantage.
What is Medicare Advantage?
Like Medicare Supplements, Medicare Advantage Plans are sold by private insurance companies. Also known as Medicare Part C, Medicare Advantage Plans offer an alternative to Original Medicare.
Medicare Advantage Plans offer several advantages over Original Medicare and Medicare Supplement Insurance:
- Part C plans are allowed to include additional benefits, such as prescription drug coverage, routine dental and vision, gym memberships, and non-emergency medical transportation, to name just a few.
- Part C plans are not allowed to deny coverage due to pre-existing conditions.
- Most Part C plans have low or no additional monthly premiums.
- Certain Part C plans, called Special Needs Plans, have specific financial, health, or institutional requirements.
- Part C plans may restrict care to their provider network.
- Part C plans are allowed to set their own deductibles, coinsurance, and copayment costs when plan members use healthcare services.
In addition to any additional premium a plan charges, all Medicare Advantage Plan enrollees are required to continue paying their monthly Medicare Part B premium.
Medicare Supplement vs Medicare Advantage: Which is Better
Medicare Supplement Insurance and Medicare Advantage Plans serve two completely different needs. One is not better than another.
In return for a monthly premium, a Medicare Supplement policy guarantees coverage regardless of how often you use healthcare services. Generally speaking, people with greater healthcare needs gain more benefits from a Medicare Supplement.
In return for a low monthly premium, or no additional premium, most Medicare Advantage plans offer access to care and additional benefits not covered by Original Medicare. Generally speaking, healthy people who rarely use healthcare services gain more benefits from a Medicare Advantage plan.
Understanding this fundamental difference is the key to choosing the best coverage. Do you want to pay most costs upfront, and know you are covered? If so, a Medicare Supplement policy may be right for you.
Do you want to pay a minimal amount upfront, get more benefits, and pay out-of-pocket when you use healthcare services? If so, a Medicare Advantage Plan may be best for you.
Can I Get Medicare Advantage and a Medicare Supplement?
Unfortunately, the answer is no. When you join a Medicare Advantage Plan you are automatically disenrolled from Medicare Part A and Part B.
Medicare regulations require that a beneficiary have both Medicare Part A and Part B to buy Medicare Supplement Insurance. As a result, insurance agents can’t enroll you in one policy if you have the other.
If you enroll in a Medicare Advantage plan and keep your Medicare Supplement Insurance (because you don’t tell your agent you have it), keep in mind that your policy won’t pay any of your Medicare Advantage out-of-pocket costs. So, it doesn’t make any sense to keep it once your Medicare Advantage coverage begins.
Medicare Supplement Guaranteed Issue Rights
Medicare Supplement Insurance is not health insurance, but there are certain protections. The most important protection is a beneficiary’s guaranteed issue right.
The guaranteed issue right allows every beneficiary to buy a Medigap policy at age 65 without answering health questions. However, once the right expires, an insurance company may make you answer health questions to determine if they want to insure you.
Under certain circumstances, you may be able to get a Special Enrollment Period (SEP) that restores your guaranteed issue right. For example, if you lose your Medigap coverage due to no fault of your own, You have the right to buy Medigap Plan A, B, C, D, F, G, K, or L that’s sold by an insurance company in your state. But, you only have 63 days after your current Medigap coverage ends to buy a new Medigap policy.
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Medicare Advantage Trial Right
Similar to the Medigap guaranteed issue right, Medicare Advantage has what’s known as a trial right. It allows you to go back to your Original Medicare and buy Medicare Supplement Insurance if you try a Medicare Advantage Plan and don’t like it.
The caveat to the trial right is that you must switch back within the first 12 months of your initial enrollment. And, you only get to use your trial right once.
The trial right applies when you are 65 and decide to join a Medicare Advantage Plan right away. It also applies if you choose Original Medicare and a Medicare Supplement at age 65.
If you have a Medicare Supplement policy, and then join a Medicare Advantage Plan, you have the right to go back to Original Medicare and get your original Medicare Supplement Plan back.
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