Medicare Supplement or Medicare Advantage PPO… What is the right plan for me?

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Hello Toni: 

Thank you for teaching my husband Charley and me the value of finding the right Medicare option for him since he retired at age 70 a few months ago.  Charley wanted to pick a Medicare Advantage PPO plan because it had a $0 monthly premium, and he could still keep his doctors even though many of the offices were out-of-network.  He found no difference between Original Medicare with a Medicare Supplement and a PPO plan except that the supplement had a larger monthly premium.

Last week Charley received a life-changing diagnosis of terminal lung cancer. Had we chosen the PPO Advantage route, then Charley and his doctor’s medical team would not be in control of his health care. Please let your readers know of our situation, because health care needs can change in a flash, like my husband’s did! Thanks, Toni.

--Janet

Hi Janet:

Americans need to understand that the premium isn’t the only difference between Original Medicare with a Medicare Supplement and a Medicare Advantage PPO Plan (MA PPO).

With Original Medicare, there is not a network; you have the freedom to use any health care provider/facility that will bill Medicare. The Medicare Supplement that you enroll in will pay for the out-of-pocket costs not covered by Medicare Parts A and B.  

Medicare Advantage PPO (MA PPO) plans have low or no premiums with lower costs for in-network providers/facilities but higher out-of-pocket costs for out-of-network benefits.  Most people on a MA PPO plan never consider they may pay an out-of-network cost for a health care provider/facility for their medical claim.

In these changing medical times, many providers or facilities nationwide are out of network with a Medicare Advantage PPO (MA PPO) plan, and you will pay more. (Visit www.medicare.gov to explore current MA PPO plan out-of-pocket costs.)

Below are differences between a Medicare Supplement and Medicare Advantage PPO plan:

(Toni’s Medicare Survival Guide Advanced edition explains Medicare Supplement and Medicare Advantage plans and what options are available when applying for a plan.)

Medicare Supplement:

• Medicare Supplements work directly with “Original” Medicare. Medicare pays its share of the Medicare-approved amount for “medically necessary” covered health care costs.
• The Supplement you pick will pay its share of the medical claim for the health care provider/facility providing the medical care.
• Medicare Part D prescription drug plans are not included in a Medicare Supplement. It is important to have your “stand alone” Medicare (Part D) prescription drug plan begin the same month the Supplement does.
• The downside to a Medicare Supplement is the monthly premium can increase each year.

Medicare Advantage PPO Plan: 

• To qualify for any Medicare Advantage plan, you must be enrolled in both Medicare Parts A and B and must live in the service area six months out of the year.
• Medicare pays the Medicare Advantage (MA) plan that you are enrolled in a specific dollar amount every month for your medical care.
• When you go to the doctor, hospital or visit your pharmacist, you must only use your Medicare Advantage Plan insurance card, not your Medicare (red, white, and blue) card. MA agents may advise the person enrolled in the MA plan to put their Medicare (red, white and blue) card away and not use the Medicare card for Medicare claims.
• A Medicare Advantage Plan must provide all your Part A and Part B benefits, and some Medicare Advantage Plans have Part D prescription drug plans included.
• “Extra” benefits such as gym membership, dental and vision may be offered.

Readers, as Janet and Charley discovered, your health care needs can change overnight. Review your options carefully, because with Medicare, it’s what you don’t know WILL hurt you!

Have a Medicare question or want to discuss Toni’s stress-free way to enroll in Medicare? Please email the Toni Says Medicare team at [email protected] or call 832-519-8664.The Medicare Survival Guide bundle package is also available on the tonisays.com website

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