When first enrolling in Medicare, one of the biggest coverage decisions involves whether to stick with Original Medicare or enroll in additional plans. Two popular options are Medicare Supplement (Medigap) Plans or Medicare Advantage Plans. But what are the main differences between these two types of coverage for Medicare beneficiaries? Let’s compare Medicare Supplement vs. Medicare Advantage Plans to understand the key characteristics of each.
Original Medicare Plan Gaps
First, it helps to understand what Medicare Supplement and Medicare Advantage Plans are designed to address. I f you are eligible for Medicare or enrolled in Original Medicare you need to pay attention.
Original Medicare consists of Part A (hospital coverage) and Part B (outpatient/medical coverage). But Original Medicare has significant out-of-pocket costs like deductibles, copays, and coinsurance. So you need to know what’s covered by Original Medicare first.
These costs can quickly add up without some form of secondary insurance to supplement what Original Medicare coverage doesn’t cover. This is where Medigap Plans and Medicare Advantage Plans come into play.
What are Medicare Supplement Insurance Plans or Medigap?
Medicare Supplement Insurance, also called Medigap, is secondary coverage sold by private insurance companies that helps pay for Original Medicare out-of-pocket costs.
Some key things to know about Medigap Plans:
- Pays for expenses like Medicare deductibles, copays, and coinsurance amounts
- Works alongside your Original Medicare benefits
- Sold by private insurers but regulated by federal and state law
- Have to accept applicants during Medigap Open Enrollment Period when first signing up for Part B
- Doesn’t cover prescription drugs
- Covers you nationwide as long as providers accept Medicare
- 10 different plan types (A, B, C, D, etc.) with standardized benefits
- Monthly premium required in addition to Part B premium
Medigap is designed to supplement costs not covered by Parts A and B of Original Medicare.
What are Medicare Advantage Plans?
Medicare Advantage, also known as Medicare Part C, offers an alternative way to receive your Medicare benefits. Key details:
- Sold by private insurance companies approved by Medicare
- Provides all of your Part A and Part B coverage
- Often includes prescription drug coverage
- Typically have copays and deductibles rather than 20% coinsurance
- Cover you through a network of contracted providers
- Many plans have $0 premiums beyond your Part B premium
- May offer extra benefits like dental and vision
Medicare Advantage Plan may provides an all-in-one alternative to Original Medicare plus Medigap.
Difference Between Medicare Advantage vs. Medicare Supplement Plan
When comparing Medicare Supplement vs Medicare Advantage, here are some of the main differences:
How they work with Medicare
- Medigap works with your Original Medicare benefits. Medicare Advantage replaces your Original Medicare.
- Medigap pays portions your Original Medicare doesn’t cover. Medicare Advantage covers all the same services as Parts A and B.
- Medigap does not offer prescription drug benefits. Many Medicare Advantage Plans include Part D drug coverage.
- Medigap allows you to see any provider that accepts Medicare nationwide. Medicare Advantage networks are usually regional or local.
- Medigap only covers portions of Medicare out-of-pocket costs. Medicare Advantage typically has copays and deductibles that cap your out-of-pocket spending.
- Medigap requires paying your Part B premium plus a Medigap policy premium. Many Medicare Advantage Plans have $0 premiums beyond the Part B premium.
- Medigap only covers Medicare Supplemental services. Many Medicare Advantage Plans offer extra benefits like dental and transportation services.
Medicare Advantage and Medicare Supplement; What’s Your Choice
So which type of plan is better for you – Medicare Supplement or Medicare Advantage? Here are some factors to consider when deciding:
- Budget – What you can afford to pay in premiums and out-of-pocket costs
- Travel habits – Whether you want national coverage or don’t mind local networks
- Provided benefits – Which coverage perks and extras matter most to you
- Prescriptions – If you want drug coverage included in your plan
- Health conditions – Whether you have complex medical needs that require specialized treatment
It also makes sense to compare specific Medigap and Medicare Advantage Plan options in your area. An insurance agent can advise on plans that align with your budget, health status, doctors, medications, and priorities.
Medicare Supplement and Medicare Advantage offer two distinct ways of getting comprehensive Medicare coverage. Understanding the main differences allows you to decide which approach makes sense for your personal situation.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Glidden Group a Call at (208) 962-0077. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
What is the difference between Medicare Advantage and Medigap?
Medicare Advantage Plans replace Original Medicare while Medigap policies supplement Original Medicare by covering costs it does not, such as deductibles and copays.
Should I get a Medicare Advantage Plan or Medigap policy?
Key factors are costs, coverage, and provider networks. Medigap generally provides more flexibility but at a higher premium, while Medicare Advantage often has extra benefits but restricted networks.
Can I switch between Medicare Advantage and Original Medicare?
During the annual election period from October 15-December 7 each year, you can switch plans free of charge. Outside of this window, you may pay penalties to rejoin traditional Medicare if eligible for Medigap.
How do Medigap Plans compare to Medicare Advantage?
Medigap Plans have standardized benefits packages labeled Plans A-N that cover costs Original Medicare leaves out. Medicare Advantage Plans can vary widely in covered services and costs.
Can I drop my Medicare Advantage Plan and get a Medigap Plan?
Only during your Medigap Open Enrollment Period while in Original Medicare Plan. This guaranteed issue period lasts 6 months after enrolling in Part B at age 65 or older.
What coverage do Medicare Advantage Plans include?
All Medicare Advantage Plans include coverage for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) benefits. Many also offer Part D drug coverage and extra benefits like dental/vision.
How do I switch from Medicare Advantage to Original Medicare?
You can disenroll from your Medicare Advantage Plan and switch back to Original Medicare during the annual election period each year. This allows buying a Medigap policy.
How can I get help choosing between options?
Contact your State Health Insurance Assistance Program for free, unbiased Medicare counseling. A SHIP adviser can help compare plans based on your individual needs and budget.
Do Medicare Advantage and Medicare Supplement Plans include prescription drug coverage?
Only some Medigap Plans (Plans H, I, J) include drug coverage. If you enroll in a Medicare Advantage, integrated Part D Plan is common but not guaranteed – you can also get standalone Part D drug plans.
What should I consider when choosing between Medigap and Advantage?
What plan to cover: Key factors are costs, coverage details, provider networks accepted, and ability to switch between options during future Open Enrollment periods if needs change.