Tag Archives: Part B

Making Sense of Medicare Advantage and Medicare Supplement

Vantage Point: Medicare Supplement or Medicare Advantage? What’s the Difference?

Have you ever had a conversation with a friend or family member where you were both thinking that you’re talking about the same thing, but then you realize (usually after much confusion and the conversation has drifted a bit), that you’re in fact not talking about the same thing?

The conversation comes to the point where you find that you’re talking about two different things, an “apples and oranges” conversation.

I think that there are a lot of “apples and oranges” conversations when it comes to what Medicare Supplement and  Medicare Advantage plans are. We’re talking about insurance with both, but they are different things.

Medicare Supplement plans, also known as Medigap plans, work with Original Medicare, which is Part A (hospital) and Part B (medical) coverage. They help pay for all or part of the 20% that Original Medicare doesn’t pay for, depending on what plan you choose. Medicare Supplement plans do not include prescription drug coverage, so if you want that, you’ll have to pick up a prescription drug plan separately.

Medicare Advantage, also known as Part C, are plans where a private insurance company replaces Original Medicare. Medicare Advantage plans have the same Part A hospital coverage and Part B medical coverage that you’d get with Original Medicare. (Remember, you’d still pay your Part B premium if you get a Medicare Advantage plan.) Plus, Part D prescription drug coverage is included in many Medicare Advantage plans. That means you’d have hospital, medical, and drug coverage together in one plan. Medicare Advantage plans may come with extras as well.

Now that the Annual Enrollment Period is here, you’ll be better equipped to have the “apples and oranges” conversations if they come up. If you still want more direction when it comes to your options, there’s a great local service available called SHIBA (Statewide Health Insurance Benefits Advisors). SHIBA is a free service of the Washington State Office of the Insurance Commissioner, Consumer Protection Division and can be reached at 509-902-1114 or 1-800-562-6900  It has great volunteers who can help you.

You can also come into our local office in Creekside Business Park, and we can go over anything you’re confused about in person, bit by bit.

We at Health Alliance Northwest in Yakima are here to help our community learn what the various parts of Medicare are to help each person make informed decisions that are the best for them. (The best choice might not be us, and we’re okay with that!)    

Breck Obermeyer is a community liaison with Health Alliance Northwest, serving Yakima County. She is a small-town girl from Naches and has a great husband who can fix anything and 2 kids who are her world.

AEP Autumn

Vantage Point: It’s That Time of Year

Days are warm and evenings crisp. Orchards bustle during the pear and apple harvest. It is my favorite time of year, but for seniors it can be stressful because of Medicare’s Annual Enrollment Period (AEP), which runs from October 15 through December 7. This is the time of year when most Medicare beneficiaries can choose or change their Medicare coverage.

Better-than-ever health care coupled with healthier lifestyles means people are living longer. With that, living on a fixed income means many seniors worry about having affordable health care for years to come.

One of the most common questions we hear in our Wenatchee office is, “What is the difference between a Medicare Supplement and Medicare Advantage plan (also known as Part C)?” Learning about each product can help people understand what best fits their lifestyles, pocket books, and health care needs.

Whether choosing a Supplement or Advantage plan, you must continue to pay your part B premium.

Medicare Supplements work much like a secondary insurance. They pick up their share of the covered health care cost after Medicare pays, depending on what plan you purchase. For example, it may pick up 10 percent of the 20 percent coinsurance (meaning you would still pay 10 percent). Supplements will not cover any cost Medicare denies, and some Supplements require medical underwriting to gauge the health of the individual. Premiums, or the cost you pay for the coverage each month, are generally more expensive. Like with Original Medicare, you can see any doctor who accepts Medicare.

Medicare Advantage plans replace Original Medicare, which means hospital and doctor visits are paid directly by the plan. Many Advantage plans also include prescription coverage making for one tidy package. To be clear, you still keep all your Medicare benefits. There is no medical underwriting, and premiums are generally lower. Advantage plans also cover extras that Medicare does not, like dental and fitness programs. They also work closely with provider offices to help coordinate care. This helps many members stay healthier. Advantage plans have contracts with provider offices so a member normally must chose a doctor within the plan’s network.

Health Alliance takes Medicare seriously, and our Wenatchee office and helpful customer service representatives are a resource you can count on to help make a great decision for you during AEP and beyond.

Visit us at 316 S. Fifth St. in Wenatchee from 8 a.m. to 5 p.m., weekdays. Or call 1-877-561-1463, TTY 711, from 8 a.m. to 8 p.m. daily. That looks like a toll-free number, but our local representatives are on the other end waiting to help.