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 told me that a Medicare Advantage PPO plan is the same as a supplement because both have a network of doctors to pick from. Seems my retiree medical plan now has a Medicare Advantage PPO plan to choose, and I’m concerned if a medical catastrophic incident happens will the medical providers, I’m now seeing accept this PPO plan and how will the facility get paid? Thanks, Stephen from Denver area.
Stephen: Your friends have given you WRONG information regarding Medicare that can lead you to choose the wrong Medicare plan for your medical situation. 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 plan, there are lower cost in-network providers/facilities as well as out of network benefits that will cost you more. In 2021, a popular Medicare Advantage PPO plan has a maximum ranging from $6,700 to $7,500 in-network while out of network costs range from$9,000 to $11,500.
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 with a Medicare Advantage PPO plan.
Below are some of the differences in the two plans:
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 providers 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) drug 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…
2) When you choose a Medicare Advantage Plan, then Medicare pays the insurance company a certain dollar amount every month for your care for the plan you are enrolled. Your Part B must always remain 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, dental and vision.
5) Verify that your providers or facilities accepts the Medicare Advantage plan enrolled in.
“October Zoom Confused about Medicare” webinar is Wednesday, October 13 at 4 p.m. Visit www.tonisays.com to sign up for Toni’s new webinar event.
Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the new 2021Medicare Survival Guide® Advanced book at www.tonisays.com or call 832-519-8664.