Understanding Medicare Supplements

According to the Centers for Medicare & Medicaid Services, 65.7 million people were enrolled in Part A and/or Part B of Medicare as of their 2023 numbers. In 2023, Medicare Advantage enrollment totaled approximately 30.8 million.

Medicare Supplement Insurance plans are offered to those enrolled in Medicare Parts A and B. These plans cover the medical expenses that the individual owes after Medicare pays its share of your medical expenses.

Medicare Advantage Plan Types

• Health Maintenance Organization (HMO) plans enable members to receive care through a network of contracted local doctors and hospitals that coordinate their care. Out-of-pocket costs may be lower for these plans than for other plans. Some plans do not require referrals for specialty care.
• Point-of-Service (POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services, typically at a higher cost. Some POS plans offer open access to providers with no referrals needed.
• Preferred Provider Organization (PPO) plans give members access to a network of contracted local doctors and hospitals, but also allow them the flexibility to seek covered services from physicians or hospitals outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.
• Private Fee-for-Service (PFFS) plans give members the freedom to receive care from any Medicare-approved provider who agrees to accept the plan’s terms and conditions of payment. Referrals are not needed for specialty care.
• Medicare Advantage Special Needs plans provide health care coverage for people with a qualifying chronic condition, those who reside in a contracted skilled nursing or assisted living facility or those who qualify for both Medicare and Medicaid (also referred to as “dual eligible”).

Medicare Part D

Medicare Part D plans are available in all 50 states and the five U.S. territories. These plans provide a way to add drug coverage to Original Medicare or Medicare supplement insurance coverage.

Medicaid

Medicaid eligibility for individuals 65 and older, or who have blindness or a disability, is generally determined using the income methodologies of the supplemental security income (SSI) program administered by the Social Security Administration (some states, known as 209(b) states, use certain more restrictive eligibility criteria than SSI’s, but still largely apply SSI’s methodologies). Eligibility for the Medicare Savings Programs, through which Medicaid pays Medicare premiums, deductibles and/or coinsurance costs for beneficiaries eligible for both programs (often referred to as dual eligible) is determined using SSI methodologies.

Consumer Resources

Some of these materials are provided by the National Council on Aging (NCOA). NCOA is a respected national leader and trusted partner to help people aged 60+ meet the challenges of aging. They partner with non-profit organizations, government, and business to provide innovative community programs and services, online help, and advocacy.

• Official U.S. Government Site for Medicare (website)
• Medicare Guidance - National Council on Aging (website)

This material is intended for both educational purposes and to promote interest in the subject matter. It does not address any individual’s specific situation and is not to serve as the basis for any purchasing decision. The material is based on the information available to me and, while deemed accurate, is not guaranteed. Numerical examples, if any, are only illustrative. Guarantees, when applicable, are backed by the financial strength and claims-paying ability of the issuing carrier. For additional information, please contact our agency.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.