Medicare Advantage vs. Medigap: How to Choose
So, you’re enrolled in Original Medicare, Part A and Part B. Congratulations – that’s a great first step, or even final step, in getting Medicare coverage. But Medicare Advantage and Medigap insurance are other Medicare coverage options you might want to consider.
This article briefly contrasts Medicare Advantage vs. Medigap insurance and includes a comparison table to help you weigh your decision.
Medicare Advantage vs. Medigap: What is Medicare Advantage?
The Medicare Advantage program, also called Medicare Part C, gives you an alternative way to get your Medicare Part A and Part B benefits. (The exception is hospice care, which Part A covers.) Under Medicare Advantage, you’re still in the Medicare program, but your benefits come to you through private insurance companies approved by Medicare.
What should I know about Medicare Advantage plans?
- Many plans include additional benefits, such as routine vision and/or dental services.
- Most plans include prescription drug coverage.
- Each plan has a yearly out-of-pocket maximum amount. This means that if you spend a certain amount on out-of-pocket costs, such as coinsurance, copayments, and deductibles, you won’t be charged for Medicare-covered services for the rest of the year.
- Some plans restrict you to doctors, specialists, and pharmacies within the plan network.
When you sign up for a Medicare Advantage plan, you must continue paying your Part B premium, along with any premium the plan may charge.
Medicare Advantage vs. Medigap: What is Medigap insurance?
Medigap insurance plans can help pay your Medicare Part A and Part B out-of-pocket costs. Coinsurance, copayments, and deductibles are some examples of these expenses. Different Medigap insurance plans may pay for different costs.
Private insurance companies sell Medigap insurance plans. There are up to 10 standardized plans available in 47 states. These standardized plans have lettered names: Plans A, B, C, D, F, G, K, L, M, and N. Plans of the same name include the same basic benefits. Costs may vary among insurance plans, even if the standardized basic benefits are the same. Some insurance companies might offer additional benefits to complement the basic benefits.
Massachusetts, Minnesota, and Wisconsin each have their own standardized Medigap insurance plans.
Medicare Advantage vs. Medigap: How do I choose?
You may be wondering which could save you money: Medicare Advantage or Medigap. The answer to that is: it depends! Your current and future health-care needs may affect your out-of-pocket health-care costs, and which option may serve you better.
Unfortunately, there’s no one-size-fits-all formula that will point you to Medicare Advantage vs. Medigap. But here are some questions that you might want to consider.
|Medicare Advantage vs. Medigap|
|Question||Something to think about||But be aware that…|
|Do you expect to have many doctor visits or hospitalizations?||Medigap insurance plans may pay your Medicare Part B coinsurance for doctor visits. They may also pay for hospital coinsurance and other hospital costs under Medicare Part A for up to one year after Medicare benefits are used up.||Medigap insurance plans typically charge monthly premiums. Also, if you apply for a plan outside the Medigap Open Enrollment Period, it’s possible that you could pay a higher premium due to your health condition(s) or that your application could be denied.|
|Do you expect to need durable medical equipment or supplies fairly often?||Medigap insurance plans may pay your Medicare Part B coinsurance for Medicare-covered medical equipment and supplies.||See above.|
|Do you take prescription drugs?||Most Medicare Advantage plans include prescription drug coverage. Medigap insurance plans sold today don’t include prescription drugs in their basic benefits.||If you decide to buy a Medigap insurance plan, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan.|
|Are you fairly healthy and don’t expect to need many doctor visits?||Many Medicare Advantage plans have low premiums some even have premiums as low as $0.||Medicare Advantage plans generally charge coinsurance or copayments for many services. Some have deductibles as well. But if you don’t go to the doctor very often, these costs may not affect you very much.|
|Is it important to you that you keep your doctor(s)?||Most Medigap insurance plans let you visit any doctor that accepts Medicare assignment.
Many Medicare Advantage plans require you to visit doctors in the plan network.
|One type of Medigap insurance plan, called a Medicare SELECT plan, might require you to visit doctors in the plan network.
Some Medicare Advantage plans let you visit any doctor that accepts Medicare assignment. In some cases, these visits could cost you more.
|Do you want benefits like routine dental or vision services?||Many Medicare Advantage plans include extra benefits, like routine dental or vision services or gym memberships.
Some Medigap insurance plans might offer extra benefits as well.
You might find it useful to shop and compare plans. Feel free to use eHealth’s Browse Plans or Get Started buttons on this page.
Medicare Advantage vs. Medigap: Can’t I have both?
Medicare Advantage plans do not work with Medigap insurance plans. This means that you cannot use your Medigap insurance plan to pay copayments, premiums, or deductibles from your Medicare Advantage plan.
There are certain situations where you may be able to have a “trial right” to enroll in a Medicare Advantage plan, and later switch to a Medigap insurance plan (and back to Medicare Part A and Part B) within a year. Read more details about Medicare Supplement Guaranteed Issue Rights.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.
The pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.