Central Illinois Medicare Supplement vs. Medicare Advantage
When it’s time to enroll in Medicare for the first time, you have a decision to make: should I purchase a Medicare Supplement or Medicare Advantage plan?
If you live in central Illinois – namely Decatur, IL and surrounding areas – this comparison guide is for you. Medicare Advantage plans are available by the county, and some counties have more choices than others. If you live in another state – or even in other parts of Illinois – your decision-making process will likely be different.
We need a basic understanding of Medicare Supplements and Medicare Advantage to compare them. If you’re already familiar with the nuts and bolts, jump ahead to our four main comparisons:
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What Is a Medicare Supplement?
Original Medicare is made up of two main parts:
- Part A, your hospital coverage
- Part B, your medical coverage
Part A helps cover things like inpatient hospital stays and hospice care. Part B helps pay for things like office visits or an ambulance.
Many people don’t realize that Medicare isn’t free, and it doesn’t pay for everything in full. There are deductibles, copays, and coinsurances left over after Medicare covers its portion.
A Medicare Supplement, sometimes called Medigap, covers some or all of the costs Medicare leaves behind. There are many different Medicare Supplement plans (organized by letter), and the government standardizes the benefits in each plan.
What Is Medicare Advantage?
A Medicare Advantage plan is an “all-in-one” network-based alternative to Original Medicare. You can’t have Medicare Advantage and a Medicare Supplement at the same time.
Medicare Advantage plans, sometimes called MA plans, are sold by private insurance companies. They bundle all your healthcare to include Original Medicare (Part A and Part B) and prescription drug benefits (Part D) in a single plan.
So, instead of signing up for a Part D drug plan and getting your hospital and medical benefits through Original Medicare, you sign up for one Medicare Advantage plan that has all these benefits combined.
MA plans often include extra benefits beyond Original Medicare, such as vision, hearing, dental, and gym memberships.
Each Medicare Advantage plan has its own out-of-pocket costs. MA plans can also have rules for how you get services. For example, you might need a referral from your doctor to get specialist services. If you have Original Medicare with a Medicare Supplement, you don’t need a referral – you can just go.
Managing your care is part of how Medicare Advantage plans control their costs, allowing their policyholders to enjoy low or even $0 premiums while also getting access to benefits that go above and beyond what Original Medicare offers.
Premium and Out-of-Pocket Costs
Cost is often the deciding factor when people compare Medicare Advantage vs. Medicare Supplements.
Medicare Advantage plans have low or $0 premiums but higher out-of-pocket costs. Medicare Supplements have monthly premiums, which vary based on many factors, but they also have very low out-of-pocket costs.
For example, our top pick for a 2021 Medicare Advantage PPO in Macon County, Illinois is the Aetna Medicare Value Advantra. It’s $0 in premium and has a $5,500 in-network maximum out of pocket.
Our top pick for a 2021 Medicare Supplement Plan G in Macon County, Illinois is from Manhattan Life Assurance Company (MAC). It’s just under $95 in premium, and the maximum amount you’d pay for Medicare-approved services in 2021 is $203.
It’s a trade-off – Medicare Supplements limit your out-of-pocket costs, but you pay a premium in exchange for that comprehensive coverage.
On the other hand, Medicare Advantage plans offer very low, or even $0 premiums, but you’re going to have a bill every time you see the doctor or are hospitalized until you reach your max out of pocket.
Example of Aetna Medicare Value Advantra MA plan vs. a MAC Medicare Supplement Plan G
Which option suits your preferences and health history better? It’s a personalized decision we can help you through. Give us a call at 217-423-8000 to schedule an appointment. You can also use our online appointment scheduler if you prefer.
A significant component of Medicare Advantage that’s not often talked about is managed care.
Medicare Advantage plans do their best to control costs, so they’ll require you to try a cheap treatment before a more expensive one, even if your doctor recommends the more expensive alternative. You’ll need referrals from your primary care physician if you want to see a specialist. You’ll also need to go through the prior authorization procedure for certain prescriptions.
Dr. Jacob D. Sams, MD, a board-certified orthopedic surgeon at Decatur Orthopedic Center (DOC), tells us the managed care component of MA plans is often a frustration in his practice.
“I’ll never forget a patient that was told a bunch of misleading things, and when the time came for surgery, their MA plan basically said they hadn’t suffered enough and had to do several more weeks of therapy. From the physician’s perspective, there are more hoops to jump through with Medicare Advantage.” Read the Full Article
MA’s managed care is in stark contrast to Fee-for-Service (FFS) Original Medicare. You control your care – not your insurance plan. Medicare Supplements have no say in your treatments, prescriptions, or doctor visits. The only rule is this: as long as Original Medicare covers it, the supplement will, too.
You can utilize the Medicare smartphone app called “What’s Covered” to help you determine if Medicare covers a particular service, test, or item. By extension, your supplement would cover it as well.
Provider networks are also a consideration, especially when looking at Medicare Advantage plans. MA plans are network-based, which means you want to see doctors in your plan’s network. The consequence of seeing an out-of-network provider depends on the plan you have. You may have no coverage at all, or your out-of-pocket costs may be higher.
The size of your provider network depends on the carrier and plan you’re considering. It gets quite confusing, which is why we recommend contacting us at 217-423-8000 before enrolling in a new plan.
Here are a few tips to help:
- PPOs have broader networks than HMOs.
- Regional carriers, like Medical Associates Health Plan, Inc, have smaller networks than national carriers, like Aetna.
- Always call your preferred physicians, pharmacies, and hospitals to ensure they accept your plan before enrolling.
- Metro areas (like Chicago) tend to have plans with better networks than rural areas and smaller cities (like Decatur).
When we evaluate Medicare Advantage plans, we always consider the network, especially if you’re a snowbird or like to travel. National brands like Aetna, Humana, and UnitedHealthcare tend to have broader networks and are improving over time.
Medicare Supplements do not have provider networks. You can see any doctor that accepts Medicare (over 90% of all doctors). It also doesn’t matter which carrier you buy your supplement from – they are all accepted by any doctor who accepts Medicare, whether they are nationally known or not.
If you are a snowbird or like to travel, we almost always recommend a Medicare Supplement. That way, you don’t have to worry about unexpected medical costs from out-of-network providers.
Medicare Advantage (MA) plans shine when it comes to added perks and benefits.
While Medicare Supplement plans have standardized benefits that help fill in Medicare’s gaps, they don’t typically come with perks or extras.
MA plans almost always come with some vision, dental, and hearing benefits. In general, these benefits are only preventative, though some plans do contribute towards major treatments. Even though the benefits may not be extensive, it’s still nice to know you have a free dental cleaning and eye exam each year.
You can also expect some type of fitness perk, such as SilverSneakers’ free fitness program that grants you access to local gyms. In central Illinois, gyms like the YMCA, Snap Fitness, Your Time Fitness 24/7, and Curves participate in SilverSneakers.
Extras and perks are exciting and add value to MA plans, but it’s important to remember you aren’t buying the plan for the extras – you’re buying it for the major medical coverage.
Consider the plan’s deductible, copays, coinsurance, and max out of pocket before diving into the extras.
For those living in central Illinois, the choice between a Medicare Supplement and Medicare Advantage plan is a careful one.
If you’re interested in Medicare Advantage, you’ll need to compare plans each year during the open enrollment period (October 15-December 7). Two years ago, we only had four plans in Macon County. For 2021, we have 17 plans available. Medicare Advantage is growing, and as central Illinois gets access to more competitive plans, we may start to see a shift in enrollment preferences.
If you need help enrolling in a Medicare plan, schedule an appointment with one of our licensed, local agents. Call us at 217-423-8000 or schedule an appointment online today!
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