Medigap and Medicare Advantage offer different options. What is best for a person depends on their particular needs.
Medigap is supplemental insurance for people who have Original Medicare. Medicare Advantage, also known as Medicare Part C, is an alternative to this plan.
The key factors that a person will need to compare to decide which option best suits their needs include coverage, flexibility in choosing doctors, and costs.
In this article, we look at the coverage options for both Medicare Advantage and Medigap plans.
Medicare Advantage and Medigap vary in the following ways:
|Coverage||Plans help cover copayments, coinsurance, and deductibles associated with Medicare Parts A and B. |
The plans do not include prescription drug coverage.
|Plans are all-in-one bundles that usually include prescription drug coverage. |
Many plans also offer dental, vision, and hearing care.
|Flexibility in choosing doctors||A person can choose any doctor who accepts Medicare.||A person must choose from doctors who are within their plan’s network.|
|Costs||Premiums are generally higher than Advantage premiums.||Premiums are usually lower than Medigap premiums. The plans also have a yearly cap on out-of-pocket costs.|
While Original Medicare pays for much of a person’s eligible healthcare expenses, it may not pay the entire amount.
Medigap is an insurance plan that supplements Medicare Parts A and B. It can help fill the gaps that copayments, deductibles, and coinsurances can create.
There are, however, health issues and treatments that Medigap does not pay for, including:
- long-term care
- private nursing
- dental care
- hearing aids
- vision care and eyeglasses
One of the benefits of having Original Medicare with Medigap is that a person may go to any doctor who is registered with Medicare, meaning that most doctors within the United States are available to them.
People who frequently travel within the country may find this option beneficial. Some Medigap plans may also pay for emergency healthcare costs outside of the U.S.
The main downside of Medigap is that the premiums may be higher than those of Medicare Advantage.
Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare. Private companies that Medicare approves can offer these plans.
Sometimes called bundles, the plans provide Medicare Parts A and B. They also often include coverage for prescription drugs.
Some Medicare Advantage plans provide extras that Original Medicare does not offer. These include benefits such as optical, dental, and hearing coverage.
One of the key benefits of Medicare Advantage plans is their costs. Premiums are generally lower, and the plans put a yearly cap on out-of-pocket costs. As a result, after someone’s medical expenses exceed the cap, they do not have to pay anything further for covered services.
However, people must weigh this up against the fact that Medicare Advantage offers less flexibility in the choice of doctors. A person must choose doctors from within their plan’s network. If they go to doctors outside the network, their costs are higher.
It is not possible for a person to have both Medicare Advantage and Medigap. The two plans do not work together.
An individual may use Medigap to help pay Original Medicare’s copayment, deductible, and coinsurance costs, but they may not use it to pay Medicare Advantage out-of-pocket expenses.
If someone has a Medicare Advantage plan, it is against the law for a company to sell them a Medigap plan unless they intend to switch to Original Medicare.
Having Medicare parts A and B is a requirement to buy a Medigap plan. The best time to buy a Medigap plan is during the 6-month open enrollment period. This window automatically begins in the month in which a person reaches 65 years of age.
Once the open enrollment period ends, the company offering a Medigap plan may decline coverage if a person has certain medical conditions.
If the company does not accept the person’s application until after the 6-month period, a higher monthly premium may apply.
Enrollment with Medigap
Medigap plans may differ depending on location. Medicare’s search tool allows a person to look at the Medigap plans available in a particular zip code.
The website provides a range of plans with different deductibles. Medigap plans are standardized, which means that they all provide the same basic benefits. However, some plans may offer additional benefits.
Once a person decides on a plan, Medicare will provide contact information for the company providing coverage. A person can then complete enrollment by contacting the company directly.
Eligibility depends on a person meeting the criteria below:
- enrolled in Medicare parts A and B
- does not have end-stage renal disease
- lives in the service area of the plan they wish to join
A person interested in joining Medicare Advantage has a choice of several plans.
Enrollment with Medicare Advantage
Medicare Advantage plans work in different ways, and a person may wish to compare plans in their particular area.
- enroll on the company’s website
- complete a paper enrollment form and then mail it to the company
- call the company and provide enrollment information over the phone
A comparison of Medigap versus Medicare Advantage shows that both options have pros and cons. There is no best choice for everyone because people have different preferences and requirements.
Medigap provides greater flexibility in choosing doctors, while Medicare Advantage often has lower premium costs. It is important for a person to examine all the differences carefully before making a decision.
Once an individual has chosen between Medigap and Medicare Advantage, they can enroll in the particular plan that suits their needs.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.