Janie Slaven: TONI SAYS: Medicare Supplements vs Medicare Advantage PPO plans

Janie Slaven, The Times-Tribune, Corbin, Ky.
·3 min read

Oct. 6—Hello Toni:

I want to tell you and the Toni Says team "Thank You" for teaching us the value of Medicare Part B and for helping enroll my husband Mike and me in Medicare the correct way when he retired at 70 a few months ago. Mike was determined to go with a Medicare Advantage PPO plan because it had a $0 monthly premium and thought that there was no difference between a Medicare Supplement and a PPO plan except cost.

Last week Mike received a life-changing diagnosis of terminal liver cancer. Had we chosen the PPO route, then Mike and his medical team would not be in control of his care. Please let your readers know of our situation because your health-care needs can change in a flash! Thanks, Toni.

—Betsy, Spring, Texas

Hi Betsy:

America needs to understand that there are differences between Medicare Supplements and Medicare Advantage PPO Plans other than premiums. They are 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 costs that Medicare Parts A and B do not pay.

With a Medicare Advantage PPO plan, there are lower costs for in-network providers/facilities as well as higher costs for out of network benefits. Most people on a PPO plan never consider they could have to pay an out-of-network medical claim, but in these current times many providers/facilities are out-of-network nationwide with a Medicare Advantage PPO plan.

Below is a rundown of the two plans:

Medicare Supplement

1. Medicare Supplements work directly with "Original" Medicare. Medicare pays its share of the Medicare-approved amount for "medically necessary" covered health care costs. The supplement will pay its share.

2. You — not the insurance plan — choose which doctor, hospital, home health agency, skilled nursing facility, etc. for your health care, so long as the provider accepts Medicare assignment. You and your health care providers are in control of your health care.

3. The downside to a supplement is that you have a monthly premium that may increase each year.

4. Medicare prescription (Part D) drugs plans are not included, so you may need to enroll in 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, you must be enrolled in both Medicare Parts A and B and must live in the plan's service area 6 months out of the year.

2. Medicare pays the insurance company a certain dollar amount every month for your care with the Medicare Advantage Prescription Drug (MAPD) plan you are enrolled in. Your Part A and 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 Plan insurance card, not your Medicare (red, white, and blue) card, and you must verify that your specific medical provider is still accepting the MAPD plan that you are enrolled in.

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. They may also have extra benefits such as gym membership, dental and vision.

To learn more, you can view your new 2024 Medicare & You handbook online or search www.medicare.gov. Take your time during Medicare's AEP to explore your many Medicare options.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Toni's books are available at www.tonisays.com with a bundle discount for Toni Says readers.