Facts on Medicare Supplements vs. Medicare Advantage

I had planned to forego any further writing on Medicare plans and Open Enrollment which is now ongoing until Dec. 7, thinking that my Nov. 2 column on MEDI, a free service staffed by volunteers that provides advice on the topic would be enough. However, the vast number of television ads and the glossy circulars favoring Medicare Advantage plans that I viewed changed my mind. You are unlikely to hear many television commercials regarding Medicare Supplement plans so this describes that alternative.

Note that for anyone who is not currently on Medicare or who does not expect to be in the near future, you can ignore these notes until they affect you or will affect you soon. But for those currently on Medicare or who will soon turn 65 or are disabled receiving Social Security Disability and are approaching the date when you are eligible for Medicare, this column is for you.

A Medicare Supplement plan (also referred to as “Medigap”) is an add-on to basic Medicare. It is standardized so that, once you sign on to the plan you know exactly what services are covered. A Medicare Supplement plan will indicate a letter such as “F,” “K” or “N.” Regardless where you obtain your coverage all Plan “G” programs, for instance will have the same benefits. The difference between companies would be in cost and customer service.

A Medicare Advantage plan on the other hand depends on the issuer. It can and often does change from year-to-year and might even change during the year. Changes to the plan could include premiums, provider networks, pharmacy networks, copays, coinsurances and deductibles so it is important to research any plan before becoming involved.

The benefits can vary widely among plans. Therefore, to the

extent that television commercials might imply without actually saying so that all of the benefits described are available with all of the plans — this is not so and the benefits provided are not consistent. For instance a plan could indicate it includes dental services but cover only preventive work. It might indicate vision but only pay a limited credit on eyeglasses. Medicare Advantage plans have a designation such as HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization).

One flyer indicated that recipients could receive free rides to their doctor’s office. Some solicitations state you may receive funds “added” to your Social Security check. This is a deduction from Part B premium available only in some locations. Others indicate $0 premiums.

Here is what you should know:

• Zero premiums does not mean zero cost. You can still and probably will have co-pays, deductibles and other expenses.

• Medicare Advantage plans generally speaking are less expensive initially but may cost more later as other expenses arise.

• Medicare Supplement plans must be accepted by any provider who accepts Medicare. This includes physicians and hospitals. Before signing with a Medicare Advantage plan make sure your preferred provider, whether physician or hospital, accepts that plan of coverage.

• Changing from Medicare Supplement to Medicare Advantage at a later date is easy. Changing from Medicare Advantage to Medicare Supplement,

not so much. If you sign with a Medicare Supplement plan and wish to change to a Medicare Advantage you are not limited in doing so. If you sign with a Medicare Advantage plan and later want to switch to a Medicare Supplement you may be unable to do so. A change from a Medicare Advantage plan to a Medicare Supplement plan is often prohibitive since it requires medical underwriting. Often patients do not think to change to a Medicare Supplement until they become more seriously ill.

• Medicare Advantage plans do not “travel” in the same way Medicare Supplement plans do. If you move to another state, for instance, and are covered by a Medicare Advantage plan, you will likely need to locate another plan.

With all this said, Medicare Advantage plans to have some attractive benefits. “Silver Sneakers” for exercise, for instance, comes to mind. It is best to get advice — and then decide.

Janet Colliton, Esq. is a Certified Elder Law Attorney from the National Elder Law Foundation recognized by the Pennsylvania Supreme Court and the American Bar Association and limits her practice, Colliton Elder Law Assocs, PC, to elder law, special needs, guardianships, estate planning and estate administration with offices at 790 East Market St., Suite 250, West Chester, 610436-6674, colliton@ collitonlaw.com. She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, co-founder of Life Transition Services, LLC, a service for families with long term care needs.