Medicare Advantage Plans vs. Medicare Supplemental Plans

Learn the important differences between Medicare Advantage and Medicare Supplemental plans.

Medicare Advantage, often called a replacement plan, combines original Medicare Parts A and B into a consolidated plan, typically including Medicare Part D prescription drug coverage. Certain Medicare Advantage plans may extend additional benefits, such as routine dental, vision, and hearing services. It's essential to emphasize that when your patient is covered by a Medicare Advantage plan, the billing process involves solely submitting the claim to that specific insurance carrier.

A Medicare Supplement plan, known as Medigap, serves as supplemental coverage, to help offset the out-of-pocket expenses that Original Medicare does not cover. In this scenario, the billing process requires submitting the claim to Medicare first, treating it as the primary insurance. The Supplemental plan is billed as the secondary insurance for the patient.

How do you know the difference when a patient gives you, their card?

It is important to carefully inspect the card provided. For most Medicare Advantage plans, the card will display wording like "Medicare Advantage" or "Medicare PPO/HMO." With Supplemental plans, you should look for the word "Supplemental" on the card. It is crucial to ensure that if the patient has a Supplemental plan, both their Medicare card and Supplemental card are obtained.

Here are a few card examples below:

Medicare Card

Medicare Advantage Card

Medicare Supplemental Card