UNITED STATES—Dear Toni: What is the difference between a “Medicare Supplement” and a “Medicare Advantage PPO” plan? I am turning 65 and the marketing material, I am being bombarded with absolutely puzzles me.
Friends have informed me that a PPO plan is the same as a supplement because both have a network of doctors to pick from. Seems my Shell Retiree plan now has a Medicare Advantage PPO plan to choose and I’m concerned if a medical catastrophic incident will the PPO plan pay? Thanks, Joseph from Clear Lake area.
Joseph: You have been given WRONG information! Medicare Supplements and Medicare Advantage Plans are completely different types of Medicare policies.
With a Medicare Supplement, there is not a network of any kind; you have the freedom to use any healthcare provider/facility that will bill Medicare. The Medicare Supplement will pay for your Medicare out of pocket that Medicare Parts A and B will not pay.
With a Medicare Advantage PPO, there are lower cost in-network providers/facilities as well as out of network benefits that will cost you more. In 2019, a popular Medicare Advantage PPO plan has a maximum $6,700 in-network out of pocket with a maximum of $10,000 out of network out of pocket.
Most never consider that they could have an out of network provider/facility for their medical claim, but in these current times many healthcare providers/facilities are out of network participants.
Below are some of the differences in the two plans:
-Medicare Supplement:
1) A Medicare Supplement works directly with “Original Medicare”. Medicare pays its share of the Medicare-approved amount for “medically necessary “covered healthcare costs.
2) Your Medicare supplement will pay its share. With a Medicare Supplement, you chose which doctor, hospital, home health agency, skilled nursing facility, etc. that accepts Medicare assignment for your healthcare. You and your healthcare provider are in control of your healthcare.
3) The downside to a Medicare Supplement is that you have a monthly premium that may increase the premium rate each year.
4) Medicare prescription (Part D) drugs plans are not included, so you may want to enroll and will pay separately for a “Stand alone” Medicare (Part D) Prescription drug plan.
-Medicare Advantage PPO Plan:
1) To qualify for any Medicare Advantage plan: a) You must be enrolled in both Medicare Parts A & B. b) Live in the service area 6 months out of a year…c) Not have end stage renal disease (kidney dialysis)
2) When you choose a Medicare Advantage Plan, then Medicare pays the insurance company a certain amount every month for your care if you are on the plan. Your Part B must always be in effect.
3) When you go to the doctor, hospital or visit your pharmacist, you must only use your Medicare Advantage insurance card, not your Medicare (red, white and blue) card.
4) 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. Also, has “extra” benefits such as gym membership, etc.
5) Healthcare facilities, like MD Anderson accept few Medicare Advantage plans. Talk to your provider or facility and make sure they accept the Medicare Advantage plan you want to enroll in whether PPO or HMO.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount to the Toni Says® readers on the Medicare Survival Guide® Advanced book at www.tonisays.com. Coming soon…Toni’s new book “Medicare Goalz 4 U…Your Guide to Enrolling in Medicare.”
