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Frequently Asked Questions

Q. What is the difference between a Medicare Supplement Policy and a Medicare Advantage Plan?

A Supplement Policy works hand and hand with Original Medicare. It pays  AFTER Medicare pays. Depending on the plan that you have chosen, it will pay the Part A deductible (for the hospital) and possibly the Part B deductible (for the doctor). It will then pay the 20% that Medicare does not pay, and will pay an extra 15% (Part B Excess Charges) if the doctor does not accept "Assignment" (the allowable charge by Medicare). Also, they will cover other things such as "foreign travel". IMPORTANT: When you have a Supplement, you can see any doctor or hospital that accepts Medicare patients in the USA. 

An Advantage Plan is a contract that Medicare has with a private insurance company to administer your benefits. It does not pay after Medicare, it pays INSTEAD of Medicare. The premiums associated with Advantage Plans are generally lower than those of a Supplement; however, when you go see a doctor or go to the hospital, you will have co-payments. There are different types of Advantage Plans. There are HMOs, PPOs, and PFFS (Private Fee for Service) plans. With HMOs, you are restricted to in-network doctors and will need to get referrals to go see a specialist. With a PFFS plan, you can see any doctor or hospital that takes Medicare, as long as they agree to accept your plan. They can accept a plan on a case by case basis. Advantage Plans are mandated to cover what Medicare covers, but they sometimes cover things at different rates. Not every doctor or hospital that accepts Medicare will accept an Advantage Plan, so you must check before you sign up for anything. If you go to a doctor or hospital that does not accept your plan, you will be responsible for the entire bill. Medicare will not pay anything. See Videos.

 

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