KBenefits Insurance Services
Supplements and MAPD

Differences Between
Medicare Supplements and MAPD's

What's The Difference?

 Medigap vs MAPD?

  • Medicare Supplements are also known as "Medigap plans".
  • MAPD: Medicare Advantage health plans with Prescription Drug coverage

Provider & Hospital Networks:

  • Medicare Supplements - Nationwide coverage
    - All hospitals nationwide accept medicare supplements.
    - About ~93% of providers nationwide accept medicare supplements.

     
  • MAPD provider networks vary carrier to carrier, plan to  plan. 
    - Out-of-state access may not be available with some plans.
    - Regional access and national access plans are available.

Plan Benefits:

  • Medicare Supplements:  Plan benefits are standardized by the government.  Private carriers are required to offer the same plan benefits as the Plan indicates.  ie.  Plan G is the same at any carrier.  All Medicare supplements use providers that accept Original Medicare.
  • MAPD:   Plan benefits vary carrier to carrier, plan to plan.  Plan benefits as well as provider networks can change upon annual renewal.  Plans can be discontinue upon renewal allowing you to select a new MAPD.

Prescription Coverage:

  • Supplements do not cover prescription.  Medicare Part D prescription coverage is use to help with the cost of your prescriptions. Plans, formularies and preferred pharmacies vary carrier to carrier but adhere to standardized plan requirements.
     
  • MAPD:   Medicare health plans have prescription coverage "built into" the health plan. So when you are considering your health plan choice you have to make sure the prescription plan also covers your medication costs.  If you want to change your prescription plan, you would have to change your MAPD plan.

Premium:

  • Medicaer Supplements:  (Higher premiums) - There is usually a higher monthly premium.
  • MAPD:  (Lower premiums) - Premiums are usually lower.

Out Of Pocket Expeneses:

  • Supplements:  (Lower)  Low deductible then Medicare A & B is covered at 100%.
  • MAPD:   (Higher)   OOP expenses include:  copays, coinsurance, deductibles. 
    Your will incur expenses until you reach your maximum out of pocket.

Flexibility:

  • Supplements: Once you enroll in a medicare supplement you can change carrier if you are medically eligible.  Medical underwriting is required.  Enrollment requests can be denied.
  • Part D prescription plans:  You can change your Part D Rx plan each year during Anuual Open Enrollment, Oct 15th thru Dec 7th.  Your new plan would start January 1st.
     
  • MAPD:   You can change your Medicare health plan every year during Annual Open Enrollment Oct 15th thru Dec 7th.  Your new plan would start January 1st.


KBenefits Insurance Services
Health - Life - Medicare

Christopher S. Kudryk
Insurance Specialist
chris@kbenefits.com
732-333-1976

KBenefits specializes in health, dental, vision, life and medicare insurance for employers and individuals in NJ & NY.

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