Medicare supplements vs. Medicare Advantage preferred provider plans

Hello Toni,

I want to thank you and the Toni Says team for teaching us the value of Medicare Part B and for helping enroll my husband, Mike, and me in Medicare the correct way when he retired at 70 a few months ago. Mike was determined to go with a Medicare Advantage preferred provider organization plan because it had a $0 monthly premium and thought that there was no difference between a Medicare supplement and a preferred provider plan except cost.

Last week, Mike received a life-changing diagnosis of terminal liver cancer. Had we chosen the preferred provider route, then Mike and his medical team would not be in control of his care. Please let your readers know of our situation because your health care needs can change in a flash! Thanks, Toni.

— Betsy, Spring, Texas


Hi Betsy,

America needs to understand differences between Medicare supplements and Medicare Advantage preferred provider organization plans other than premiums. They are different types of Medicare policies.

With a Medicare supplement, there is not a network of any kind; you have the freedom to use any health care provider/facility that will bill Medicare. The Medicare supplement will pay for your Medicare costs that Medicare Parts A and B do not pay.

With a Medicare Advantage preferred provider plan, there are lower costs for in-network providers/facilities as well as higher costs for out-of-network benefits. Most people on a preferred provider plan never consider they could have to pay an out-of-network medical claim, but in these current times, many providers/facilities are out-of-network nationwide with a Medicare advantage preferred provider plan.

Below is a rundown of the two plans:

Medicare supplement

1. Medicare supplements work directly with original Medicare. Medicare pays its share of the Medicare-approved amount for "medically necessary" covered health care costs. The supplement will pay its share.

2. You — not the insurance plan — choose which doctor, hospital, home health agency, skilled nursing facility, etc. for your health care, so long as the provider accepts Medicare assignment. You and your health care providers are in control of your health care.

3. The downside to a supplement is that you have a monthly premium that may increase each year.

4. Medicare prescription (Part D) drugs plans are not included, so you may need to enroll in and will pay separately for a stand-alone prescription drug plan.

Medicare advantage preferred provider organization plan

1. To qualify for any Medicare Advantage plan, you must be enrolled in both Medicare Parts A and B and must live in the plan's service area six months out of the year.

2. Medicare pays the insurance company a certain dollar amount every month for your care with the Medicare Advantage prescription drug plan you are enrolled in. Your Part A and Part B must always remain in effect.

3. When you go to the doctor, hospital or visit your pharmacist, you must only use your Medicare Advantage plan insurance card, not your Medicare (red, white and blue) card, and you must verify that your specific medical provider is still accepting the prescription drug plan you are enrolled in.

4. A Medicare Advantage plan must provide all your Part A and Part B benefits, and some Medicare Advantage plans have Part D prescription drug plans included. They may also have extra benefits such as gym membership, dental and vision.

To learn more, you can view your new 2024 "Medicare & You" handbook online or search medicare.gov. Take your time during Medicare's annual enrollment period to explore your many Medicare options.

Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Toni's books are available at tonisays.com with a bundle discount for Toni Says readers.

Upcoming Events