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Differences between a supplement and a medicare advantage plan

By April Lujan, The Health Insurance Store 505-200-0069

Recently we have been receiving a great deal of question regarding the differences between a Supplement and a Medicare Advantage Plan.  The most common question; is why should I spend money for a Supplement (Medigap) when I have a $0 premium HMO?  My response is, if you are going to go with a Medicare Advantage Plan HMO or PPO we normally recommend a $0 premium HMO, if they are available in your area.  Be aware however, that not all $0 premium plans are created equal.  You want to make sure your plan has the lowest out of pocket cost and the largest network of doctors and hospitals in your area.

There are several reasons people choose to go with a Medicare Supplement.  The most important reason is people on Supplements have access to virtually every doctor or hospital in the entire country.  In the Santa Fe area and other parts of the state we have crazy hospital, doctor, and network issues where many of the providers only accept one or two Advantage Plans.  In fact, some of the major companies don’t allow you to access UNM hospital, which has the only trauma unit in the state.  Also, in the event of a serious disease many HMO plans will not allow people to receive care outside the state at world class facilities such as the Mayo Clinic in Phoenix or M. D. Anderson Cancer Center in Dallas.  This is really troubling to me because, I have had several personal friends and family members who would not be alive if they did not have access to out of state facilities.

The other reason why people make the choice to spend a little more money on Supplements is that there is little or no out of pocket costs for any Medicare covered services such as X-rays, CT scans, hospitalization, and most other medical services.  With your HMO or PPO Advantage Plan, there is a cost or copay for almost every service.  A short hospital stay for example could cost anywhere from $1000 to $1875.00, or more.  Please don’t think we are anti-Advantage Plan, they are very popular and work well for many people on a fixed income.  However, if you want the ability to see any doctor or facility in the country that accepts Original Medicare please consider what I have discussed.

We provide guidance and assistance in applying for Medicare Insurance Plans at no cost to you.  If you would like to send a question to the Medicare and Health Insurance experts please email me at April@getyourbestplan.com or call me at 505-200-0069

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