Medicare Advantage vs. Medicare Supplement

What’s the Difference?

A family tells me their mom has United Healthcare, or Humana, or Cigna and Medicare. That name alone doesn't quite tell you what's actually covering her.

Here's the mix-up I run into: people don't realize the difference between manage Medicare and Traditional Medicare.

Manage Medicare (Medicare Advantage)

is where an insurance company is managing their Medicare benefits. The insurance company holds the purse strings and decides (authorizes) how their Medicare dollars are spent.
Their (United Healthcare, or Humana, or Cigna… ) rules
Their approval process
Their final word overrides the Medicare Guideline you saw online.

Traditional Medicare

is where there is no insurance company managing the benefits. Authorizations are not usually required. This does not mean anything goes because the service or need still have to meet Medicare criteria.

Supplemental Insurance also called Medigap

works with Original Medicare. The add-on, if you will, to the main policy. Pays for additional costs original Medicare leaves behind, such as certain deductibles, copays, or coinsurance.
Important: Medigap is not used with Medicare Advantage.

Caregiver Tip:

1. Clarify if an insurance company is managing their Medicare? Many often aren’t sure.

2. Then ask if they have any other insurance card(s) besides the red, white and blue Medicare card.

3. If they do, what is that second coverage? Medigap? Medicaid? Employer coverage? Something else? If you’re not sure, call the number on the insurance card and ask: “Is this plan providing their Medicare benefits, or is it supplemental coverage?”

That one question can clear up a lot of confusion.

And it tells you who you need to call next when there’s a question about coverage, authorization, or a bill.