August 30, 2022
Medicare Advantage & Medigap: What’s the Difference?
There are some healthcare costs that Original Medicare (Medicare Part A and Part B) won’t pay. To help with these, many Medicare users enroll in a Medicare Advantage Plan or Medicare Supplement Insurance policy (Medigap). However, you may not have both a Medicare Advantage Plan and Medigap at the same time. So if you want coverage beyond Original Medicare, you will have to make a choice.
Healthpilot can help. Healthpilot can search many of the Medicare Advantage and Medigap plans available in your area to find the right one for your specific healthcare needs. It’s fast, easy, secure and all online. Now, here are the key differences between Medicare Advantage and Medigap.
|What is it?
Note: Medicare Parts A and B are required to have Medicare Advantage or Medigap.
|Medicare Advantage includes all the services covered under Medicare Part A and Part B. Learn the basics of Medicare here.
Many plans cover routine dental care, vision care and prescription drugs.
|Medigap helps pay your share of medical expenses like co-pays, deductibles and coinsurance after Medicare pays for services covered by Part A and Part B.|
|How does it work?||Your doctor sends the bill to your Medicare Advantage plan.
The amount you pay for services (co-pays, deductibles, etc.) is set by your Medicare Advantage plan, and approved by Medicare.
|Your doctor sends the bill to Medicare.
Medicare pays its share, then passes the rest of the costs to your Medigap plan for payment.
|Cost||Low or no monthly premium. But you do have to pay cost-sharing (co-pays, deductibles, etc.).
Note: You must still pay your Medicare Part B premium.
Can be a great option for people who are primarily concerned about paying high premiums.
Cost can change from year to year.
Medicare Advantage Plans have an annual maximum out-of-pocket cost (MOOP) which limits the total amount of money you have to pay in a year for Medicare Part A and Part B.
|Higher monthly premium than Medicare Advantage but your out-of-pocket cost-sharing is very predictable.
Medicare Supplement insurance plans and what they cover are fully standardized. (For example, one plan F covers the exact same things as another plan F from another carrier.)
Can be a great option for people who are primarily concerned about paying high out-of-pocket costs if they get sick.
|Drug coverage||Often includes a Medicare Part D Prescription Drug Plan. Convenience of one card for Medicare Parts A, B and D.||Does not include drug coverage, but you can easily add a Medicare Part D Prescription Drug Plan.|
|Additional Benefits||May include routine dental and vision care, gym discounts and reimbursement for medically necessary transportation.||Some Medigap plans cover care when you travel outside the U.S.
While Medigap does not cover dental or vision care, some plans offer a dental or vision discount program. You can also purchase separate plans for these services.
|Network||With HMO plans, you must use in-network doctors and choose a primary care physician.
With PPO plans, you can see a doctor out of network, but pay more.
Seeing a specialist may require a referral.
|More freedom of access.
No primary care physician required. No networks.
If your doctor takes Medicare, they will also take your Medigap plan.
|When to Enroll
Most people become eligible for Medicare three months before turning 65. If you are disabled, you can become eligible earlier.
|You can enroll in Medicare Advantage during one of Medicare’s enrollment periods. Learn which enrollment period is right for you here.||The best time to get a Medigap policy is during your Medigap Open Enrollment Period (OEP). Your Open Enrollment Period starts when your Medicare Part B coverage goes into effect and ends six months later.
If you apply for Medigap after your Open Enrollment Period, your premiums may increase, or you may be denied Medigap coverage completely due to your health status. These rules vary by state.
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