Medicare Supplement vs Medicare Advantage: A Virginia Beach Senior's Guide

One of the most important Medicare decisions you'll make is choosing between Medicare Supplement insurance (also called Medigap) and Medicare Advantage plans. This choice affects everything from which doctors you can see to how much you'll pay for medical care.

After helping Virginia Beach, Norfolk, and Chesapeake residents with this decision for over 24 years, I can tell you there's no universal "right" answer – but there IS a right answer for your specific situation, health needs, and budget.

Let me break down both options in plain English so you can make an informed decision.

Understanding Your Medicare Foundation

Before we compare supplements and advantage plans, let's review what you already have with Original Medicare (Parts A and B):

Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facilities, and some home health care.

Medicare Part B (Medical Insurance): Covers doctor visits, outpatient care, medical equipment, and preventive services.

What Original Medicare Doesn't Cover: Prescription drugs, dental, vision, hearing aids and Long-Term Care

Both Medicare Supplement and Medicare Advantage plans are designed to fill some of these gaps – but they do it in very different ways.

Medicare Supplement (Medigap): The Predictable Choice

Medicare Supplement insurance works alongside Original Medicare to pay for costs that Medicare doesn't cover, like deductibles, copays, and coinsurance.

How It Works:

1. You keep Original Medicare Parts A and B

2. You add a Medicare Supplement plan (Plan G is most popular)

3. You add a separate prescription drug plan (Part D)

4. When you need medical care, Medicare pays first, then your supplement pays most or all of the remaining costs.  You are able to go to any doctor, nurse practitioner, PA, Specialist or Hospital that accepts Medicare all over the United States.

   
   

Advantages of Medicare Supplement Plans:

Predictable Costs: You know exactly what you'll pay each month in premiums. Medical expenses are largely covered with minimal out-of-pocket costs.

Doctor Freedom: You can see any doctor or specialist who accepts Medicare – no network restrictions. This is especially valuable in Hampton Roads where we have excellent specialists. If you travel you have confidence knowing you can get care wherever you may need it by a Medicare provider.

No Referrals Needed: You can go directly to specialists without getting approval from a primary care doctor.

Travel Coverage: Your coverage works anywhere in the United States, perfect for Virginia Beach residents who travel or have seasonal homes.

Guaranteed Renewable: As long as you pay your premiums, your coverage can't be cancelled due to health changes.

Medicare Advantage: The All-in-One Option

Medicare Advantage plans replace your Original Medicare and typically include prescription drug coverage plus extra benefits in one package.

How It Works:

1. You enroll in a Medicare Advantage plan instead of Original Medicare

2. The plan provides benefits substantially like Medicare benefits plus prescription drugs

3. Many plans include extra benefits like dental, vision, and wellness programs

4. You typically pay copays or coinsurance for services 

   
   

Advantages of Medicare Advantage Plans:

Lower Monthly Premiums: Many plans have $0 monthly premiums, though you still pay your Medicare Part B premium.

Extra Benefits: Most plans include prescription drugs, and many add dental, vision, hearing aids, and wellness benefits.

Out-of-Pocket Maximum: Plans have annual limits on your medical expenses (usually $3,000-$11,500), providing protection against catastrophic costs.

Coordination of Care: Plans often emphasize preventive care and care coordination, which can lead to better health outcomes.

Disadvantages of Medicare Advantage Plans:

Network Restrictions: You must use doctors and hospitals in the plan's network, except for emergencies. Going out-of-network can be expensive.

Referral Requirements: You typically need referrals from your primary care doctor to see specialists.

Annual Changes: Plans can change networks, formularies, and costs each year, requiring annual review.

Geographic Limitations: Coverage is limited to the plan's service area, which could be problematic if you travel frequently or move.

Which Option Works Best for you ?

Choose Medicare Supplement If You:

• Want maximum doctor choice and flexibility

• Prefer predictable healthcare costs

• See specialists regularly

• Travel frequently

• Have chronic health conditions requiring ongoing care

• Can afford higher monthly premiums for lower out-of-pocket costs

Choose Medicare Advantage If You:

• Want to minimize monthly premiums

• Like having everything in one plan

• Are comfortable with network restrictions

• Want extra benefits like dental and vision

• Are generally healthy with minimal medical needs

• Prefer copays to percentage-based coinsurance

  
  

Local Considerations for Hampton Roads Residents

Healthcare Systems: Our area has excellent healthcare through Sentara, Bon Secours, and other systems. Medicare Supplement gives you access to all providers, while Medicare Advantage plans vary in their network coverage.

Specialist Access: Hampton Roads has outstanding specialists. If you want unlimited access to specialists without referrals, Medicare Supplement is typically better.

Seasonal Residents: Many Virginia Beach residents spend time in other states. Medicare Supplement provides nationwide coverage, while Medicare Advantage plans have geographic limitations.

Making Your Decision: Questions to Ask Yourself

1. How important is doctor choice flexibility to me?

2. Do I want predictable monthly costs or am I willing to budget for variable medical expenses?

3. How often do I currently use medical services?

4. Do I take expensive medications?

5. Do I travel frequently or spend time outside Virginia?

6. What's my total healthcare budget (premiums + out-of-pocket costs)?

   
   

Get Personalized Guidance for Your Situation

Choosing between Medicare Supplement and Medicare Advantage is one of the most important healthcare decisions you'll make in retirement. The right choice for your neighbor might be wrong for you, based on your health, finances, and preferences.

As your local Medicare broker in Virginia Beach, I help Hampton Roads residents analyze both options based on their specific circumstances. I'll show you actual plan options available in our area, calculate real-world costs based on your medications and health needs, and explain how each option works with our local healthcare systems.

Call Retha Rish Insurance Agency at 757-692-8388 or email rrish@asb.insure to schedule your personalized Medicare consultation.

Don't make this important decision based on TV commercials or general advice. Get guidance that's specific to your situation and our local Hampton Roads healthcare market.

Your retirement years should be focused on enjoying life, not worrying about healthcare costs or coverage limitations. Let me help you choose the Medicare option that gives you both peace of mind and financial security.