|Comparison||Medicare Advantage||Medicare Supplement|
|Eligibility||Must have Parts A and B, and live in service area. Takes all applicants except those with End Stage Renal Disease (some exceptions).||Must have Parts A and B. Usually companies may deny, but must accept all applicants, all ages, during Initial Enrollment and Guaranteed Issue periods.|
|Costs: Premium,copay,coinsurance,out-of-pocket maximum||All plan members pay same premium regardless of age,gender, or health. Cost sharing (copays) must be paid for most medical services. Many plans have an out-of-pocket annual maximum.||Premium varies with gender and health and goes up with age. Companies may underwrite (add to premium). Generally, no copay costs at time of service. No out-ofpocket maximum.|
|Provider choice and availability: Always verify your providers accept plan||HMOs and PPOs maintain provider network; they must have available providers in order to accept new members.|
PFFS has no provider network; it may be hard to find providers who accept it in some areas.
HMO: Generally covers in-network only. Referrals may be required for specialist visits.
PPO: Covers out of network, but then costs may be higher. No referrals required.
|No network: Go to any provider that accepts Medicare. No referrals required for specialist visits.|
May be hard to find providers accepting Original Medicare in some areas.
May be used for treatments at major medical facilities, such as Mayo Clinics, OHSU, etc.
|Prescription drug coverage: Make sure your MAPD/PDP covers your Medications Rx||If you want Rx coverage, you must enroll in the included Rx coverage if choosing an HMO or PPO. (VA-eligible excepted.)|
With PFFS, you may choose either the plan's Rx coverage, if offered, or a stand-alone PDP.
|Not included. If you want Rx coverage, you may enroll in any stand-alone (PDP) plan available.|
|Renewable:||No, benefits may change yearly. However, you usually remain in a plan unless you disenroll at election times.||Yes, guaranteed renewable as long as you pay the premium and the application was correct. Benefits never change. No election season for Medigaps.|
|Extra Benefits:||Some plans include routine dental, vision, or physicals. Some offer additional alternative medicine package.||Covers only same as Original Medicare. No routine dental, vision, or physicals; no alternative medicine.|
|Whom it may be best for:||Network plans may be good for people who otherwise can't find a Medicare provider. May save money unless you need frequent appointments or treatments. |
Having a packaged plan may simplify choices.
|Good for travelers or "snow birds". May save money for people needing high-cost or frequent care. Customize elements of your Medicare picture-choose doctors and drug plan. |
|How to comparison shop:||Plans are not standardized -use comparison pages in this Guide or at www.medicare.gov. Plans are regulated by Medicare/CMS; sales agents are licensed by OID.||Because Medigaps are standardized, price and customer service are the only difference. Regulated by Federal government and State of Utah Insurance Division .|