Medicare Advantage Versus Medicare Supplements: Comparison for Agents
When it comes to selling Medicare products, there tends to be a lot of misconceptions. For starters, when your client enrolls into Medicare through social security they are enrolling in part A and B coverage, also called Original Medicare. This coverage is offered by the government and not what Medicare agents sell. Â
Medicare Advantage and Medicare Supplements, however, are plans offered by private companies. These plans provide more extensive coverage from what clients already receive from Original Medicare in addition to a range of additional benefits such as dental, vision, hearing and drugs coverage depending on which plan your client chooses.Â
Let’s take a look at a couple of other topics that often get confused when it comes to differences between Medicare Advantage and Medicare Supplement products.
What is Medicare Supplement Coverage?
Medicare Supplements, also known as Medigap or MedSupp for short, are higher premium plans that clients pay in addition to Original Medicare. They charge extra premiums to fill in the coverage gaps that clients are exposed to when enrolled in Original Medicare with Parts A and B.
With Medicare Supplements, clients are often left to pay little or no co-pays and don’t have to worry about doctor networks, as MedSupps are always accepted. However, for Medicare clients eligible for Medicare after 1/1/2020, Plan F is no longer available but there are still plenty of options. If your client was already on Medicare or eligible prior to 1/1/2020, then they can still enroll in Plan F.Â
What Medicare Part A Covers
Medicare Part A is the hospital insurance portion of Medicare that helps cover the cost of inpatient healthcare services.Â
It generally pays for inpatient hospital stays, skilled nursing facility care following a qualifying hospital stay, hospice care for individuals with a terminal illness, and certain medically necessary home health services. While Part A covers many essential hospital-related expenses, beneficiaries are still responsible for deductibles, coinsurance, and costs associated with services or extended stays that exceed Medicare’s coverage limits. For most people, Medicare Part A is premium-free if they or their spouse paid Medicare taxes while working for the required number of years.
What Medicare Part B Covers
Medicare Part B is the medical insurance portion of Medicare that helps cover outpatient healthcare services and medically necessary care.Â
It generally includes doctor visits, preventive services, outpatient procedures, diagnostic tests, laboratory work, durable medical equipment, ambulance services, mental health care, and many other medically necessary treatments. Part B also covers a wide range of preventive benefits, such as annual wellness visits, screenings, and vaccinations, to help detect or prevent health conditions early. Unlike Part A, most beneficiaries pay a monthly premium for Part B, as well as an annual deductible and coinsurance for many covered services.
What About Medicare Part D?
Now you may have noticed we have not addressed part D at all which is prescription drug coverage. Medicare Supplements do not cover part D and need to be paired with a Prescription Drug Plan or PDP.
What is Medicare Advantage Coverage?
Medicare Advantage, also known as Medicare Part C, is an alternative way to receive Original Medicare benefits through private insurance companies approved by Medicare.Â
These plans are required to provide the same coverage as Medicare Part A and Part B, but many also include additional benefits such as prescription drug coverage, routine dental, vision, hearing, fitness programs, and wellness services. Medicare Advantage plans often feature provider networks, such as HMOs or PPOs, and may have different premiums, copayments, and out-of-pocket costs than Original Medicare.Â
Coverage options, costs, and available benefits vary by plan and geographic location, making it important for beneficiaries to compare plans each year to find one that best meets their healthcare needs. Medicare Advantage plans are usually lower premium plans, often $0. These plans are cheaper monthly but have a lot more gaps in coverage. For these plans you would need to make sure that your clients doctors are in network and compare drug coverage among the available options in your clients residential area. While sounding like a daunting task we have a platform where you can enter in all of this information and it will tell you the best options followed by enrollment options from that same screen.Â
Need more information on how to help cross sell products to help cover these gaps? Sign up for our webinars or check out our Medicare Advantage and Medicare Supplement blogs to stay up to date on the latest news and industry insights.
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The most common reason I hear why agents don’t want to sell Medicare products is that they don’t want to deal with annual certifications. It’s important to note, you do not need to certify in order to sell Medicare Supplement products. This is crucial for agents specializing other types of insurance.Â
For example, life and annuity agents who don’t want to spend a lot of time on certifications to sell Medicare can sell MedSupp coverage by just having their life and health license (which they would already have). For Part D and Medicare Advantage products however agents do need to take the AHIP certifications each year.
For life insurance agents and annuity agents who have sold Medicare Supplements, but cannot sell the Part D without AHIP, they should visit medicare.gov. There, agents can enter their client’s drug information to see the best options, and have the clients enroll. A popular option, this offers lower commissions on drug plans than that of a Medicare Advantage or Supplement plan.
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At Pinnacle Financial Services, our team makes Medicare easy for our agent partners. We provide all of the technology and training necessary for insurance professionals to be successful in selling Medicare products. Consider us your back office!
For more information, contact a Pinnacle Representative today at 1-(800)-772-6881 x7731 or email sales@pfsinsurance.com.
Bob Brzyski
Vice President, Strategic Growth & Marketing
x7742 | bbrzyski@pfsinsurance.com
