What Are The Differences Between Medicare Advantage And Supplement Insurance Plans

The differences between Medicare Advantage and Supplement Insurance plans are significant. They are different products and are mutually exclusive. You can't sign up for both. Both exist to help plan members with medical bills not covered by Medicare. Supplemental coverage helps with these bills. Advantage coverage is private insurance that replaces Medicare and Supplemental coverage.


Medicare, funded and managed by the federal government, is offered to anyone over 65, and to individuals with specified disabilities. Part A is coverage for hospital care. Part B assists with visits to doctors offices. Part C allows for Advantage (privatized) coverage, and Part D covers prescription drugs. Part D is government regulated but the coverage must be purchased separately. It's not an automatic benefit.

Supplemental insurance (Medigap) is billed after the government has paid it's covered portion of the bill. Government regulations set the standard options for supplemental policies. Plans are the same no matter where you buy them or who you buy from. Individuals decide which options to purchase. Premiums are pricey and no additional benefits are allowed within this type of coverage. Prescription drug coverage still has to be purchased separately.

Part C allows beneficiaries to elect for private coverage that can offer additional benefits such as vision and dental. Advantage plans maintain a contract with the government receiving payment for the taxpayer funded portion of coverage on a monthly basis. They charge plan members a premium based on the extra benefits they choose.

Most Part C policies offer coverage for prescription drugs, hearing, vision, and dental care, as well as preventive care options. Plan members pay a co-pay and coverage usually starts after a deductible, but premiums are less than those charged for supplemental policies, and additional benefits are available.

Part C policies have few exclusions. They're easy to qualify for. There is a specified enrollment period of 3 months before and after turning 65, or individuals can switch to Advantage coverage between 11/15 and 12/31 of every year. Most are HMO plans, but PPO's can be purchased also. Many private companies offer Part C coverage. They're private policies so premiums and benefit options can vary a lot. Do your research to find the best policy for your needs.

Supplemental plans are harder to qualify for. There are certain grace periods when they have to accept an applicant. When individuals first become eligible for Medicare they have 6 months to decide. If they choose supplemental coverage at this time they can't be turned away. Other exceptions provide for individuals to try out private insurance without penalty. If they cancel Part C coverage within 6 months they can enroll in supplemental coverage. An individual dissatisfied with supplemental coverage can switch to private coverage, and change their mind within 6 months, still being eligible for supplemental coverage. Outside these windows, applicants can apply for supplemental coverage all year round, but the medical underwriters do not have to approve the coverage. Beneficiaries can always cancel private policies to return to traditional Medicare with no exceptions.

The federal government provides a benefit guide detailing the benefits and the differences between Medicare Advantage and Supplement Insurance Plans. They also have a website for additional information and contacts. Online insurance sites allow beneficiaries to browse the many plan offerings. Insurance coverage can be confusing. An experienced agent can be a knowledgeable and helpful resource also.

USA Medicare Solutions offers free assistance to those with Medicare Visit ChoicesForMedicare.com