What is the difference between a Medicare Supplement and a Medicare Advantage PPO Plan? I am turning 65 and I am being bombarded with marketing material. Friends have told me that a Medicare Advantage PPO Plan is the same as a Medicare Supplement because both have a network of doctors to pick from. My retiree employeer medical plan now has a Medicare Advantage PPO. I am concerned if a medical incident happens – will the providers I am seeing now accept this Medicare Advantage PPO Plan?
Stephen, from Denver
Are Medicare Supplements and Medicare Advantage PPO Plans the Same?
Your friends have given you wrong information regarding Medicare. This can lead you to choose the wrong plan! 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 or facility that will bill Medicare. The Medicare Supplement will pay what your Medicare Parts A and B will not.
With a Medicare Advantage PPO Plan, there are lower cost in-network providers or facilities as well as out of network benefits that will cost you more. In 2022, a popular Medicare Advantage PPO Plan has a maximum ranging from $5,400 to $7,550 in-network, while out of network costs range from $7,550 to $11,300.
Medicare Moments: Prescription Drug Costs Have Risen Dramatically! Here Are 5 Ways to Stay Out of The Medicare Part D “Donut Hole!”
Most never consider they could have an out of network provider or facility for their medical claim, but in these current times, many healthcare providers and facilities are out of network with a Medicare Advantage PPO Plan.
Let’s take a look at the key differences in the two plans:
- Works directly with Original Medicare. Medicare pays its share of the Medicare-approved amount for medically necessary costs.
- Your Medicare Supplement will pay its share. You chose which doctor, hospital, home health agency, skilled nursing facility, etc. that accepts Medicare assignment for your healthcare. You and your healhcare providers are in control of your healthcare.
- The downside to a Medicare Supplement is that you have a monthly premium that may increase the premium rate each year.
- 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 plan.
Medicare Advantage PPO Plan
- To qualify for any Medicare Advantage plan you must be enrolled in both Medicare Parts A & B and live in the service area 6 months out of a year.
- When you choose a Medicare Advantage Plan, Medicare pays the insurance company a certain dollar amount every month for your care for the plan you are enrolled. Your Part A and Part B must always remain in effect.
- When you go to the doctor, hospital, or visit your pharmacist, you must only use your Medicare Advantage Plan insurance card, not your Medicare (red, white, and blue) card. Verify that your specific medical provider is still accepting the MAPD plan that is being enrolled in.
- A Medicare Advantage Plan must provide all your Part A and B benefits and some Medicare Advantace Plans have Part D prescription drug plans included. Also, has extra benefits such as gym membership, dental, and even vision.
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