Medicare Advantage vs. Medicare Supplement: how to choose

Once you have Parts A and B, you face a fork in the road. You can keep Original Medicare and add a Medicare Supplement (also called Medigap) plus a Part D drug plan, or you can choose a Medicare Advantage plan that bundles everything together. Both paths are good. The right one depends on how you use health care and what kind of risk you are comfortable with.

How each path works

With a Supplement, Medicare pays its share of every approved claim first, and your Supplement pays most or all of the rest. You can see any doctor or hospital in the country that accepts Medicare, with no referrals and no networks.

With Medicare Advantage, a private insurance company manages your Medicare benefits. You use the plan's network of doctors and hospitals, pay copays as you use care, and usually get drug, dental, vision and hearing benefits in the same plan.

Cost: premium now versus copays later

Supplements have a higher monthly premium. In Sarasota County, a Plan G for a 65-year-old often falls somewhere between $145 and $210 a month (sample range). In return, your yearly medical costs are very predictable. With Plan G you pay the Part B deductible and little else.

Many Advantage plans in our area have a $0 premium. You pay as you go instead: a copay for a specialist, a daily amount for a hospital stay, coinsurance for some procedures. Every plan has an out-of-pocket maximum, which protects you in a very bad year, but that maximum can be several thousand dollars.

• If you rarely see a doctor, Advantage often costs less over the year.
• If you have ongoing specialist care or a planned surgery, a Supplement often costs less in total.
• Always compare total yearly cost: premium, copays and drugs together.

Doctors and networks

If there is a specific specialist or cancer center you would travel for, a Supplement gives you that freedom. Advantage HMOs require you to use network providers and often need referrals. PPOs allow out-of-network care at a higher cost.

Before choosing an Advantage plan, check every doctor you care about. Networks change from year to year, so this is also something to recheck each October.

Travel and snowbird life

Many of our clients spend summers in the Midwest or Northeast. With a Supplement, your coverage works exactly the same in Michigan as it does in Sarasota. With most Advantage plans, only emergency and urgent care are covered when you are away. A few PPOs offer travel programs, but they have limits.

Switching later is not always easy

This is the detail that matters most in Florida. You can leave an Advantage plan during the Annual Enrollment Period, but buying a Supplement after your first six months on Part B usually means answering health questions. If you have developed a serious condition, a carrier can decline you.

That is why we encourage people who think they may ever want a Supplement to consider it during their Medigap Open Enrollment Period, when acceptance is guaranteed.

A simple way to decide

Ask yourself three questions. Do I want to keep specific doctors no matter what? Do I spend months outside Florida? Would a surprise bill of several thousand dollars keep me up at night? If you answered yes to any of these, lean toward a Supplement. If you are healthy, stay local and value low premiums plus extras, an Advantage plan may fit well.

Still torn? Bring your doctor list and medications to a free appointment and we will show both options with your real numbers.