A MAC is committed to helping our members understand their Medicare options. One of the most common ques- tions asked by our members is “What is the difference between a Medicare Supplement plan and a Medicare Advantage plan?” We have developed this brief outline to help answer this question. Keep in mind that each plan is unique. The information provided below is a summary, not a comprehensive description of benefits. Questions? Call our Medicare Advisory Service at 800-940-3976 or visit amac.us/medicare MEDICARE 101 A :F%) k c%)Ac%Fc: M)%FCA)
Medicare Supplement (Medigap)
Medicare Advantage (Part C)
Works with your Original Medicare benefits (Parts A & B) Must have Medicare Parts A & B
Replaces your Original Medicare benefits (Parts A & B)
How They Work
Must have Medicare Parts A & B and live in the service area 1
Eligibility
May apply for coverage year-round
Has specific enrollment periods 2 No underwriting requirements
Enrollment
Subject to Medical Underwriting 3 if applying outside of an Open Enrollment 4 Period or Guaranteed Issue period 5 (state specific exceptions may apply) Often higher premiums but may have little to no out-of-pocket expenses for Medicare approved services No network- can see any provider throughout the country that accepts Original Medicare Use both your Medicare card and Supplement insurance card for medical services- you will have a separate card for prescriptions (if you purchased Part D) Can be used in any US state or territory. Some plans offer foreign travel emergency benefits for international travelers. Prescription drugs are not covered. May purchase a standalone Prescription Drug plan (Part D) at an additional cost
Underwriting
Often lower premiums but may have deductibles, copays, and coinsurance for Medicare approved services Network plans (HMO, PPO, PFFS): the provider must agree to accept the plan unless in an emergency/urgent situation Use only your Medicare Advantage insurance card for medical services and prescriptions (if included in plan). Emergencies and urgent services are covered when travelling domestically or internationally (up to plan limits). Routine services may not be covered when travelling These plans can be purchased with or without prescription drug coverage May offer additional benefits like Dental, Vision, OTC allowance, Hearing, etc.
Premiums
Network
Insurance Cards
Portability
Prescriptions
Additional Benefits
Not covered
Guaranteed renewable 6 if you pay the premium when due
Plans are subject to change each year
Renewability
1. Service area: A geographic area where the plan accepts members. The plan may limit membership based on where people live. / 2. Enrollment period: Defined period of time with a specific start and end date for registering in a plan to receive benefits.. / 3. Medical Underwriting: A process used by insurance companies whereby they evaluate your health status to help them decide whether or not to oer you coverage and at what price. / 4. Open Enrollment Period: This period automatically starts the first month you have Medicare Part B / 5. Guaranteed Issue: Rights you have in certain situations when insurance companies must oer you certain Medigap policies. / 6. Guaranteed Renewable: A requirement that the insurance company cannot cancel your Medigap policy if you continue to pay the premium when due.
ƗĊ • AMAC Magazine
v16i5-medicare-101.indd 1
9/19/2022 4:31:29 PM
Powered by FlippingBook