Medicare Plus supplement vs. Medicare Advantage (Maybe) 2026– Healthful Hints

'Tis the season to think about the holidays (which seem to start right after Labor Day), and, if you're a member of that susceptible target age group, you likely are getting dunned and harassed by Medicare Advantage medical insurance companies.

On our caller ID we've had four to five unsolicited calls from the medical insurance giant company Humana, which I purposely haven't answered. In the mail, we have received a few missives from United Health peddling their version via AARP.

The above is what I wrote in 2023. I am re-running this column about the differences between original Medicare and Medicare Advantage plans (maybe). This time, it's because a majority of those companies are eliminating patients' Advantage Plans because they don't make enough money for the company. People are having to shop for new medical insurance.

Even if you aren't ready yet, someday you just might be old enough for Medicare (if it's still available and not taken away). Even so, you may still be doing battle with your own private medical insurance company. It seems everyone is now forced to do this, so this hint might have relevant information.

The primary difference between Medicare, which came into being in 1965 as a blessing for so many older folks on limited incomes, and Medicare Advantage plans (MAPs) is that the U.S. government administers Medicare, while MAPs are sold by private insurers to supplement Medicare, under rules set by the government. The private company contracts with Medicare to sell the plans. Medicare pays a monthly fee for each enrolled patient.

Medicare is an alphabet soup. It has 4 basic parts: A, B, C, and D. Part A pays on hospital care. Part B pays on doctor visits, procedures and equipment. Part C is Medicare Advantage. Part D pays for prescription drugs. Original Medicare (OM) Parts A and B require patients to pay a deductible before the plan starts paying, but these are not very high. After the deductibles, it pays all but 20%, for which you are responsible. There is no upper limit to that, which can add up to some pretty hefty totals if you are really sick and using doctors and hospitals.

Medicare supplement insurance is sold by private companies and called Medigap insurance. It protects people against sky-high expenses and bankruptcy. (Half or more of all personal bankruptcies today are from medical costs. What a sad social commentary.)

To make things even worse, the allowed Medigap plans are labeled A, B, C, D, F, G, K, L, M, and N. (What happened to the letters in between?) These are supposedly standardized, except in Massachusetts, Minnesota or Wisconsin, where they are standardized differently. Aren't we special? What is covered and the premium amounts differ by letter.

MAPs are similar to private insurance plans. Each has different benefits and rules. For 2020 there were over 3,100 plans offered around the country. Most of them have restrictions on which "providers" you can see, and require referrals to specialists, unlike OM. To get truly bogged down, you can look up the different plans on Medicare.gov's plan finder. Too much for this small column. MAPs were originally created in 1997 as Medicare+Choice . The name changed in 2003 to Advantage.

MAPs automatically cover essential Part A and B benefits, except hospice services. The plans' benefits and fees vary widely. They tend to cover everything with a co-pay, which is set by the company rather than by any government rule. Their main selling attraction is that they often cover (at least in part) eye and hearing exams and prescription drugs, so there is no need to buy Part D drug coverage separately as with Medigap plans.

Key differences are that Medigap plans may have higher premiums but no co-pays, while MAPs have lower premiums, even zero or nothing, but higher co-pays. If you are healthier in general, MAPs may have an "advantage" monetarily. But they generally limit you to doctors and facilities within their Health Maintenance Organization/HMO or preferred Provider Organization/PPO. They often operate only in a region. If you are a "snowbird" living in more than one state per year, OM plus Medigap may be better coverage than any MAP.

The best thing to do is to find a live human you can trust who sells more than one plan, so they aren't biased toward only one company, which they will always say is the best. It was a lot easier when you/I could make a house call on your/my bike, and get a pie or a bag of fresh vegetables for the visit. A recent article about the insurance shake-up in Minneapolis Star Tribune said that the MAP cutting was worst in Minnesota. A classic quote from it is, "Many seniors, however, don't enjoy shopping for insurance." How to understate the obvious? There, now didn't I make it simple to understand? (Joke) Happy shopping?

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