Medicare Advantage and Medicare Supplement Plans are two popular options that provide additional coverage for Medicare beneficiaries. But they work very differently. Understanding the key distinctions between Medicare Advantage and Medigap Plans can help you determine which type best fits your healthcare and budget needs.
In this comprehensive guide, we’ll explain what each entails, compare their costs and coverage, when they make sense to consider, and how to choose the right plan for your situation.
What is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, refers to private Medicare Plans from insurance companies that are approved by Medicare. Here are the basics of Medicare Advantage:
- Plans cover all Medicare Part A and Part B benefits
- Most Medicare Advantage Plans include prescription drug coverage
- Fixed out-of-pocket costs like copays rather than 20% coinsurance
- Prefers using in-network doctors, hospitals and pharmacies
- Often extra benefits like dental, vision, hearing
- Maximum annual out-of-pocket limit on costs
Medicare Advantage Plans combine Part A, Part B and usually Part D into one plan. They provide an alternate way to receive your Medicare benefits through a private insurer.
What is Medicare Supplement Insurance?
Medicare Supplement insurance, or Medigap, is separate coverage from private insurers that fills gaps in what Original Medicare covers. Here is how Medigap policies work:
- Help pay Medicare out-of-pocket costs like deductibles and coinsurance
- Work alongside Original Medicare to provide more coverage
- Standardized plans to cover (A, B, C, D, etc) with defined benefits
- Can see any provider accepting Medicare nationwide
- No prescription drug benefits – need separate Part D Plan
- Premiums required monthly in addition to Part B premium
Medigap Plans work as an enhancement to Original Medicare by covering certain costs that you would otherwise pay out of pocket.
Key Differences Between Medicare Advantage and Medigap
While both Medicare Advantage and Medigap provide additional coverage, there are clear differences:
- Replaces Original Medicare
- Usually has prescription drug coverage
- Copays and maximum out-of-pocket limit
- Network restrictions
- Often extra benefits like vision and dental
- Works with Original Medicare
- No drug coverage
- Pays Medicare deductibles and coinsurance
- See any provider accepting Medicare
- No extra benefits beyond filling gaps
Some key considerations if debating between Medicare Advantage or Medigap include:
- Network flexibility – Advantage has networks, Medigap does not
- Drug coverage – Most Advantage Plans include it, Medigap does not
- Predictable costs – Advantage has copays, Medigap pays percentage
- Extra benefits – Advantage offers additional benefits, Medigap does not
- Travel coverage – Medigap offers coverage nationwide
So in summary, Medicare Advantage provides an alternate way to get all your Medicare benefits while Medigap acts as a supplement to enhance Original Medicare.
Medicare Advantage Plan Details
Medicare Advantage Plans are offered by private insurers who have been approved by Medicare to provide coverage. Here are some plan specifics:
- Monthly premium – Plans may charge $0 to $150 per month on average
- Deductible – Some plans have a deductible, but many have a $0 deductible
- Out-of-pocket maximum – Cannot exceed $8,300 in 2023 for Parts A and B
- Copays – Set dollar amounts for services like doctor visits rather than 20% coinsurance
- Network – Plans have network providers you generally must use
- Referrals – Often need referrals to see specialists
- Prescription drugs – Most plans include Medicare Part D coverage
Medicare Advantage offers simplicity by rolling all your coverage into one plan. But the trade-off is you generally must use in-network providers and pharmacies.
Medicare Supplement Plan Details
Medigap Plans help fill gaps in Original Medicare coverage by:
- Deductibles – Pay Medicare Part A and Part B deductibles
- Coinsurance – Pay 20% coinsurance for Medicare services
- Copays – Cover Medicare copay amounts
- Hospital costs – Pay extra hospital days beyond Medicare limits
- Foreign travel – Provide emergency coverage when traveling abroad
- Enrollment – Can enroll at any time if under 65 with a disability or special needs
- No networks – See any provider that accepts Medicare nationwide
- Private insurers – Plans sold by private insurance companies
The range of costs Medigap Plans cover allow you to reduce your out-of-pocket spending significantly compared to only having Original Medicare.
Medicare Advantage vs Medigap Cost Comparison
Weighing the costs between Medicare Advantage and Medigap requires looking at premiums, deductibles, drug coverage, and total out-of-pocket spending.
Medicare Advantage costs:
- $0 to $150 monthly premium on average
- Deductible from $0 to $480 in 2023
- Integrated prescription drug coverage
- Maximum $8,300 out-of-pocket cap in 2023
- $120 to $350 monthly premium on average
- Pays Medicare deductibles (Part A is $1,600 in 2023)
- Need separate Part D Plan for drug coverage
- No annual out-of-pocket maximum
Medigap Plans provide security knowing you won’t incur major healthcare costs not covered by Medicare. But the trade-off is higher monthly premiums.
Carefully adding up all costs under both options allows an apples-to-apples comparison to see which provides the most value and protection based on your specific healthcare needs.
When to Consider a Medicare Advantage Plan
Certain situations where enrolling in a Medicare Advantage Plan may make sense include:
- You want all benefits rolled into one plan
- You are comfortable using a limited provider network
- You want extra benefits like dental and vision
- You want maximum out-of-pocket cost protection
- You take few specialty medications not on plan formularies
- You don’t qualify for Medigap due to health conditions
Medicare Advantage Plans appeal to those who want consolidation, simplicity, budget protection, and expanded benefits.
When to Consider a Medicare Supplement Plan
Here are some instances when sticking with Original Medicare plus a Medigap Plan may be preferable:
- You want flexibility to see any doctor accepting Medicare
- You want to avoid network restrictions
- You want coverage when traveling anywhere in the U.S.
- You take expensive specialty drugs a plan may not cover
- You have a pre-existing condition that prevents buying Medigap later
- You are comfortable paying deductibles and 20% coinsurance
Those who highly value provider choice flexibility and specialized drug coverage needs may benefit more from Medigap.
How to Choose Between Medicare Advantage and Medigap
When deciding between Medicare Advantage and Medigap, first consider your healthcare priorities:
- Do you have strong provider or facility preferences?
- How important is drug coverage – especially for specialty medications?
- Do you want maximum out-of-pocket cost protection?
- Do you travel frequently throughout the U.S.?
- How important are extra benefits like dental or vision?
- What is your monthly premium budget?
Next compare specific plan options for costs and coverage details. Having a Medicare insurance broker walk you through the pros and cons of Medicare Advantage vs. Medigap simplifies making the right plan choice.
Be sure to evaluate plans every year during Medicare’s Annual Enrollment Period. Your healthcare needs and plan options may change from one year to the next.
Key Takeaways – Medicare Advantage vs. Medigap
- Medicare Advantage offers consolidated coverage through private insurers
- Medigap fills gaps and reduces out-of-pocket costs with Original Medicare
- Advantage Plans have networks, Medigap allows you to see any provider
- Most Advantage Plans include drug coverage, Medigap does not
- Medigap offers protection against high healthcare costs
- Shop carefully each year to select the optimal coverage for your situation
Understanding the core benefits and limitations of both Medicare Advantage and Medigap Plans empowers you to make the right Medicare Plan choice based on your healthcare priorities.
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 Think65 a Call at (719) 301-1220. 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 a Medicare Advantage Plan and a Medicare Supplement or Medigap Plan?
Medicare Advantage and Medicare Supplement Plans are both private health insurance plans that can provide additional coverage beyond Original Medicare. However, they work in different ways. A Medicare Advantage Plan is an all-in-one alternative to Original Medicare that includes both hospital (Part A) and medical (Part B) coverage, as well as additional benefits like prescription drug coverage (Part D) and sometimes even dental, vision, and hearing services. On the other hand, a Medicare Supplement or Medigap Plan is designed to help pay for some of the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
What do Medicare Advantage Plans offer?
Medicare Advantage Plans offer all the benefits of Original Medicare (Part A and Part B) and usually include additional coverage, such as prescription drug benefits (Part D), dental, vision, and hearing services. Some plans may also offer extra benefits like fitness programs or nurse hotlines. It’s important to review each plan’s coverage and benefits to find the one that best fits your needs.
What do Medicare Supplement or Medigap Plans offer?
Medicare Supplement or Medigap Plans are designed to fill in the gaps of Original Medicare coverage. These plans help pay for some of the out-of-pocket costs you would normally have to pay, such as deductibles, copayments, and coinsurance. However, they typically do not include prescription drug coverage, so you may need to enroll in a separate Part D Plan.
Can I have both a Medicare Advantage Plan and a Medicare Supplement Plan?
No, you cannot have both a Medicare Advantage Plan and a Medicare Supplement Plan at the same time. These are two different types of plans that cannot be used together. You must choose one or the other to provide additional coverage beyond Original Medicare.
Can I switch from a Medicare Advantage Plan to a Medicare Supplement Plan?
Yes, you can switch from a Medicare Advantage Plan to a Medicare Supplement Plan, but there are some important considerations to keep in mind. First, you must be within your initial enrollment period or have a qualifying special enrollment period to make this change. Second, you may need to go through medical underwriting, which means you could be denied coverage or charged higher premiums based on your health status. It’s important to carefully compare your options and speak with a licensed insurance agent to understand the implications before making a decision.
What is the best Medicare Plan for me?
The best Medicare Plan for you depends on your individual needs and preferences. Consider factors such as your health status, budget, preferred doctors and hospitals, prescription medications, and any additional coverage or benefits you may desire. You may find that a Medicare Advantage Plan offers the right combination of coverage and affordability, or you may prefer the flexibility and choice provided by a Medicare Supplement Plan. It’s important to carefully review each plan’s details and compare them against your personal needs before making a decision.
If I switch from a Medicare Advantage Plan to a Medicare Supplement Plan, can I return to Original Medicare?
Yes, if you switch from a Medicare Advantage Plan to a Medicare Supplement Plan, you can return to Original Medicare. It’s important to understand the rules and regulations regarding enrollment and disenrollment periods to ensure a smooth transition. You may also want to consider enrolling in a Part D prescription drug plan if your Medicare Supplement Plan does not offer this coverage.
What is the difference between Medicare Advantage and Medicare Supplement Plans?
The main difference between Medicare Advantage and Medicare Supplement Plans is the way they provide additional coverage. Medicare Advantage Plans are an all-in-one alternative to Original Medicare, offering both hospital and medical coverage (Parts A and Medicare Part B), as well as additional benefits and services. Medicare Supplement Plans, on the other hand, work alongside Original Medicare, helping to pay for certain out-of-pocket costs like deductibles and copayments. It’s important to compare the different coverage options and benefits of each plan to determine which one best fits your needs.