I signed up for Medicare a few years back when I turned 65. But every time I call to get information on my plan, it’s such a hassle trying to explain myself. My supplement plan is a PPO, but they keep telling me it is not a supplement plan. I am confused to say the least. Can you tell me exactly what a supplement plan is?
-Alex (Canton, OH)
Understanding Medicare can be a tedious task, not to mention all the terminology that goes with it! It’s no wonder that with all the different parts and plans that some beneficiaries mistakenly refer to their coverage as a “Supplement” plan. As licensed insurance agents, our Medicare Advisors have heard everything under the sun referred to as a “Supplement” plan, from Employer Group Health Plans to Medicare Advantage Plans (Part C).
Although technically your thought process is not wrong, a Medicare Supplement is a specific type of coverage, also known as a Medigap plan.
Here are 5 ways to tell if you have a Medicare Supplement Plan (aka Medigap):
- Medicare Supplement plans DO NOT have networks. If your plan operates off a network like an HMO, PPO, or PFFS, then you do not have a Supplement plan. A true Supplement plan offers nationwide coverage, allowing you to see any physician or facility that accepts Original Medicare.
- Although some Supplement plans included drug coverage in the past, no Supplement plan sold after 2006 will include drug coverage. If your current plan includes drug coverage, chances are you do not have a Medicare Supplement plan. Most people have a separate drug plan in addition to their Supplement policy, to help pay for their prescriptions.
- Since a Supplement plan works with your Original Medicare, you must present your red, white & blue Medicare card AND your Supplement insurance card when you receive health care. If you are only showing one card, double check what it says. If it does not say “Medicare Supplement” with a plan letter (e.g., Plan F, G, N, J, etc.) then you probably have a different type of plan.
- Medicare Supplement plans DO NOT cover routine Dental, Vision, or Hearing. Most people have a separate policy for this in addition to their Supplement coverage. If this is included in your plan, you do not have a Supplement policy.
- Lastly, your monthly premium for a Medicare Supplement plan is often higher than what you would pay monthly for another type of Medicare plan, like a Medicare Advantage plan. Supplement plan premiums are NEVER taken out of your Social Security check. So, the amount of your premium and the mode in which you pay them are another good indication of whether or not you have a Supplement plan.
It is important to know your correct plan type and name, especially when you are seeing a new doctor or making plan changes. We have heard countless stories of doctors’ offices telling patients their visit wouldn’t be covered because their doctor is not in the network for their plan. Again, there is no network with a Supplement plan. So, if your doctor accepts Original Medicare, they also accept your Supplement plan. On the other hand, if you say you have a Supplement plan, but you truly do not, then you could wind up paying out of pocket costs that could have been avoided by knowing your correct plan type.
Additionally, when discussing plan options, your Advisor will ask you what type of plan you have now and/or what you are interested in. Be sure to use the correct terminology, or you may wind up unintentionally comparing apples to oranges or enrolling in a plan that you may not have chosen otherwise. Your Advisors do their best to assist, but by giving them the correct information, you can avoid miscommunications.
That being said, it sounds like you might not have a Supplement plan since you mentioned your plan has a PPO network. If you’d like to discuss this in more detail, please give us a call at the number below. We’re happy to help!
Thank you for taking the time to write us.
Your Medicare Advisor
If you would like to review specific plan options, our licensed agents here at AMAC are happy to assist you. They are licensed with top-rated insurers throughout the country.
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