Comparison Between Original Medicare and Medicare Supplement VS Medicare Advantage

QUESTION	ORIGINAL MEDICARE (Parts A & B)	Medicare Advantage (Part C)	MEDICARE SUPPLEMENT (Medigap)
Who provides the coverage?	Federal Government	Private Insurance Companies	Private Insurance Companies
How is the Plan Funded?	Payroll taxes paid by employees, employers, and self-employed individuals; funds authorized by Congress; and premiums paid by Beneficiaries.	The plan receives a fixed amount per enrollee per month from Medicare plus the Beneficiary’s Part B premium. It may also charge a premium to the member.	Premiums paid by the policyholder.
Do I continue to pay my Part B premium?	Yes	Yes	Yes

Can my policy be cancelled?

NO, unless changed by an Act of Congress

YES. Contracts operate on an annual basis upon approval by CMS.

NO. Once you purchase a policy, it can only be terminated if you do not pay your premium on time or you made a material misrepresentation on your application.

What does the plan cover?

Part A is

Hospital Insurance
Part B is Medical

Insurance

At least what Original Medicare covers plus additional benefits not covered by Medicare.

Pays eligible expenses (based on the plan you purchased) not paid for by Medicare such as deductibles and/or coinsurance/copayments.

Can I use my own doctors and hospitals?

Yes

NO, you must use providers in your plan’s network unless it is a medical emergency.

Yes

What options are available?

Part A and Part B provides the same coverage for everyone.

The insurance company generally offers a choice of plans with varying copayments and costs. Most plans include prescription drug coverage. Depends on the plan and the company

Effective with policies purchased on and after June 1, 2010, you can choose Plan A, B, C, D, F, G, K, L, M, or N. The plans are standardized for all insurance companies.

Is pre-certification required?

Generally, YES. Penalties may apply if you do not follow the plan’s rules.

What impact does the New Health Care Law have?

HEALTH REFORM
LAW

The guaranteed Medicare benefits you currently have will remain the same.

Beginning in 2011, Part B will cover a free annual physical. You will pay NO deductible or coinsurance for most preventive care services like colorectal cancer screening and mammograms.

Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare. You still receive guaranteed Medicare benefits, but these overpayments will be gradually eliminated starting in 2012. Beginning in 2014, at least 85% of every dollar these plans receive must be spent on health care, rather than administrative costs and insurance company profits.

NONE. The good news is that once you have a Medicare Supplement policy, it cannot be changed except to coincide with changes to Medicare’s deductibles, coinsurance, and copayments. For example, if your policy pays the Part A deductible, each year as the Part A deductible increases, your policy will pay the increased deductible.