Suppose you’re navigating the world of Medicare. In that case, you may wonder whether it’s possible to simultaneously have both a Medicare Advantage plan and a Medicare Supplement Insurance plan (also known as Medigap). This question arises because both options offer distinct benefits, and understanding how they work together can help you make an informed decision about your healthcare coverage.

What is Medicare Supplement Insurance?

Medicare Supplement Insurance assists in paying for certain out-of-pocket expenses related to Original Medicare (Parts A and B). These costs can include coinsurance, copayments, and deductibles. Depending on the plan, Medicare Supplement Insurance may also cover emergency medical care while traveling outside the country.

Private insurance companies sell Medicare Supplement plans, each offering a specific set of benefits. The plans are standardized, meaning that a Plan G from one insurer offers the same coverage as a Plan G from another insurer. Up to 10 different plans are available, labeled A through N, each covering various benefits in varying degrees.

Some of the benefits provided by Medicare Supplement Insurance include:

  • Coverage for inpatient hospital costs up to a year after your Medicare Part A benefits run out.
  • Payment for Medicare Part B coinsurance costs.
  • Payment for hospice care coinsurance under Medicare Part A.

Medicare Supplement plans, however, do not provide coverage for prescription medications or any services that are excluded by Original Medicare, including hearing, vision, and dental care. Additionally, they cannot be used with a Medicare Advantage plan.

What is Medicare Advantage?

Medicare Advantage, or Medicare Part C, is an alternative way to receive Medicare benefits through a private insurance company. These plans integrate the benefits of Original Medicare (Part A and Part B) and might provide additional advantages such as prescription drug coverage (Part D), dental, vision, hearing services, and wellness programs.

A major benefit of Medicare Advantage plans is their ability to offer a complete, integrated approach to healthcare. This means you can receive all of your healthcare services through a single plan, simplifying your healthcare management. Medicare Advantage plans may offer lower out-of-pocket costs. Nonetheless, they usually impose network restrictions, meaning you may need to choose specific doctors and hospitals that belong to the plan’s network.

Can I Combine Medicare Supplement with Medicare Advantage?

It is not possible to have both a Medicare Supplement plan and a Medicare Advantage plan at the same time. While these two plans aim to fulfill similar roles, they operate in distinct ways. It is prohibited for an insurance company to offer you a Medicare Supplement policy while you are enrolled in a Medicare Advantage plan, unless you can demonstrate that you are exiting the Medicare Advantage plan. Once you choose to enroll in a Medicare Advantage plan, you can no longer utilize your Medicare Supplement plan. The coverage provided by Medicare Advantage already includes the benefits offered by Original Medicare and additional benefits, meaning that you don’t need a Medigap plan for supplemental coverage.

Comparing Medicare Advantage vs. Medicare Supplement

Deciding between Medicare Advantage and Medicare Supplement relies on your individual healthcare requirements. To help you decide, here’s a quick comparison of the two options:

Coverage

Medicare Advantage: Includes Original Medicare Parts A and B, plus additional benefits like dental, vision, and hearing care.

Medicare Supplement: Covers the expenses that Original Medicare doesn’t pay, addressing out-of-pocket costs.

Enrollment

Medicare Advantage: Limited enrollment periods.

Medicare Supplement: You can enroll anytime after turning 65 and being enrolled in Part B.

Doctors and Hospitals

Medicare Advantage: may require the use of in-network providers.

Medicare Supplement: You can see any physician that takes Medicare.

Referrals

Medicare Advantage: May require referrals for specialists.

Medicare Supplement: No referrals are needed.

Costs

Medicare Advantage: Lower premiums, but copayments apply.

Medicare Supplement: Higher premiums but little to no copays.

Prescription Drugs

Medicare Advantage: Often included in the plan.

Medicare Supplement: It is not included but requires a separate Part D plan.

Medical Underwriting

Medicare Advantage: No medical underwriting is required.

Medicare Supplement: Medical Underwriting may be required outside of open enrollment.

Understanding the Medicare Advantage Trial Right Period

The Medicare Advantage Trial Right period allows individuals to try a Medicare Advantage plan for the first time. If you determine that the plan doesn’t suit your needs, you have the option to revert to Original Medicare within the first year. This trial period allows you to explore Medicare Advantage without being locked into it long-term.

If you exit a Medicare Advantage plan during this timeframe, you can buy a Medicare Supplement plan and sign up for a Medicare Part D prescription drug plan. This ensures that you’re still covered with the supplemental benefits you may need.

When is the time frame for enrolling in a Medicare Advantage Plan?

You have the opportunity to sign up for a Medicare Advantage plan during specific enrollment periods, including the Annual Enrollment Period (AEP), which runs from October 15 to December 7. If you enroll during this period, your coverage will begin on January 1. There are also other enrollment periods throughout the year, such as the Initial Enrollment Period when you first become eligible for Medicare.

What Happens If I Cancel My Medicare Supplement Plan?

If you cancel your Medicare Supplement plan, you may face challenges if you decide to re-enroll later. Outside of the Medicare Supplement Open Enrollment Period, you might be subject to medical Underwriting, making it harder to get coverage if you have pre-existing conditions.

Selecting the Appropriate Option for Your Healthcare Requirement

Choosing between Medicare Advantage and Medicare Supplement Insurance is a choice that is influenced by your healthcare requirements, financial situation, and individual preferences. While combining both types of coverage is impossible, you can choose the plan that best fits your lifestyle and provides the coverage you need. Whether you opt for the all-in-one approach of Medicare Advantage or the more flexible coverage of Medicare Supplement, understanding the benefits and limitations of each will help you make the right choice.