The Benefits of a Medicare Supplement over a Medicare Advantage Plan


This is a personal recount of how one can spare themselves of having the financial burden of a Medicare Advantage plan.


During the annual election period in the fall of 2016, I had someone approach me as to the differences between a Supplement with traditional Medicare over a Medicare Advantage plan.


To preface, the client lived in rural area of North Carolina and the closet hospital was over an hour away. While the doctors in his home town were in network.  The hospital was not.


I informed him that he was only covered in the county in which he lived for in-network procedures. This made him uneasy since the hospital was in an entirely different county.


He had routine physicals an office visits throughout the year, in which a Medicare Advantage had worked just fine.  After all, he was only paying $40/month for health care coverage.


We weighed the pros and cons of the 2 different options for him.  The pros and cons he really considered were with a Medicare Supplement plan you pay a higher premium, but the plus was there were no deductibles and copays nor were there networks.  He could go to any doctor!  Very much appealing to him.  (the premium for a supplement Plan F at that time was roughly $110/month.  The pros for the Medicare Advantage plan were that he had lower premiums with prescription drug coverage included, as well as he opted for the dental coverage for an additional $20/month.  He seemed to have the packaged deal.  The cons were that he was only covered in-network in his county with a select number of doctors.  If anything, catastrophic were to happen, he would have to go to Mission Hospital in Asheville, North Carolina. This was incredibly disconcerting for him and made his wife uneasy.


After careful though, he opted to switch to the Medicare Supplement and disenroll in his Medicare advantage plan.  We signed him up for the Plan F with an effective date of 1/1/17 and a prescription plan for an additional $12.60/month.  The total premium outlay was $122.60, including both the supplement and the prescription plan.


On July 17th, 2017, the now client suffered a massive stroke and was transported to Mission Hospital.  He ended up having to stay in Hospital for 7 days.  His wife was extremely nervous about the hospital bill, but I reassured her that if Medicare paid, the supplement would pay the balance.  The total bill was near $130,000!  Once they received their explanations of benefits, it showed everything had been paid!  They Owed nothing!!


In sum, for a total annual premium of $1,320, he was covered with no deductibles, no networks, no copays. If he would have had the Medicare advantage plan, he would have had a Maximum Out of Pocket of $7,500 with the insurance company having the ability to dictate what was covered and what wasn’t.


A Medicare Supplement might not be a good fit for everyone, but as you age you will statically have more health claims.  Consider all your options and talk with an insurance specialist at Laurels Insurance Partners today!