At MediGap Advisors, we champion healthcare freedom.
It’s one of our core values.
We believe that individuals should be free to choose their healthcare providers without being confined by network restrictions.
We believe that consumers don’t have medical freedom until they are free to choose their own providers based on quality and the value provided to them. Not to some managed care insurance company who builds their care networks around the lowest bidders in town.
But not all private Medicare add-on plans support that choice.
This blog post will explain which types of private plans allow you the freedom to select your own doctors, hospitals, and other providers, and which restrict your benefits for non-emergency care to their narrow list of approved providers.
Medicare Advantage Plans: A Managed Care Option
Medicare Advantage Plans, also known as Part C, provide a low-cost option for price-sensitive seniors.
They’re offered by private insurance companies approved by Medicare.
They tend to be affordable on a month-to-month basis. Many plans are available at zero premium.
But they come with two significant drawbacks: Limited provider networks, and higher potential out-of-pocket costs if you do need care.
Limited Provider Networks
Medicare Advantage plans are HMOs or PPOs. As such, they operate by contracting with a limited network of providers who agree to offering discounted rates in exchange for a steady flow of patients.
This limits your choice of healthcare providers.
You are not free to use your benefits with any provider, but must limit non-emergency care to providers in the plan’s network.
Higher Maximum Out-of-Pocket Costs (MOOPs)
Additionally, while Medicare Advantage plans offer much lower premiums on the front end, your exposure to health care costs on the back end is much greater:
Medicare Advantage plans come with potential out-of-pocket costs as high as $8,850, as of 2024.
Few people who have trouble affording a Medigap plan with a much lower maximum out-of-pocket exposure can afford an $8,850 risk – much less one that renews every year.
Medicare Advantage plans work best for those in excellent health, who want to keep monthly out-of-pocket costs as low as possible, and who don’t expect to consume much health care in the near-to-intermediate term.
It also works best for those who can afford potentially thousands of dollars in out-of-pocket costs if they lose that bet.
Finally, Medicare Advantage works best if you have a plan that already includes your desired providers, or you are ok with having your plan limit your provider choices when you need care.
Get a Free Medicare Supplement Quote
Medigap Plans: Freedom to Choose
Medigap plans, short for Medicare supplement insurance, complement Original Medicare (Part A and Part B). and provide freedom from network constraints.
They fill in the gaps in Original Medicare, including out-of-pocket costs, copayments, deductibles, and coinsurance.
And they allow you to use your plan with any doctor or provider that accepts Medicare assignment.
Medigap plans require a monthly premium. But you are not limited to the providers your managed care plan selects for you. You are free to shop around and use your benefits with any provider in the country.
Some Medigap plans even provide benefits for care received out of the country.
Medicare Advantage plans are standardized across different insurance companies, which means that their coverage remains consistent from carrier to carrier.
The most popular plan currently available, Medigap Plan G, covers all your out-of-pocket costs under Medicare Parts A and B except your Part B annual deductible of $240, as of 2024.
That’s a far cry from the max out-of-pocket exposure from Medicare Advantage plans.
Medi-Share 65+: An Affordable Health Sharing Alternative
Medi-Share 65+ is an innovative, money-saving health sharing alternative to Medigap plans.
It’s a health sharing plan designed exclusively for Medicare beneficiaries age 65 and older who are enrolled in both Medicare Part A and Part B.
Unlike Medigap plans, Medi-Share 65+ plans are not health insurance products. Instead, Medi-Share is a non-profit association of like-minded, health-conscious individuals who agree to help share unexpected health care costs of other members.
And again, unlike Medicare Advantage plans, Medi-Share 65+ allows you to choose your own doctor and provider.
They offer very similar sharing benefits compared to Medigap Plan G, but are available at a fraction of the cost in nearly all markets.
Under Medi-Share 65+, your maximum out-of-pocket exposure for combined Medicare Part A and B cost per year is $500 per household, not per person.
Medi-Share 65+ Saves Money
Unlike Medigap plan costs which vary with age, sex, and location, as well as with the type of plan you select.
Average premiums for standard Medigap plans can exceed $160 per month, and in some cases, they may even reach $361 or more.
In contrast, the Medi-Share 65+ monthly contribution costs are as low as $99 for individuals aged 65-74 and $150 for those aged 75 and older.
This is the same across the country, for both men and women.
Those enrolling now get a level price guarantee until they turn 75.
Additional Savings and Benefits
Medi-Share 65+ leverages its extensive membership to negotiate discounts with healthcare providers.
Members also receive a Select Savings Card, offering substantial savings on various healthcare items and services.
Medi-Share 65+ Exclusions
As a Christian health-sharing ministry, Medi-Share 65+ has certain exclusions.
These include expenses related to suicide or attempted suicide, self-inflicted injuries, abortion of a live fetus, DUI-related injuries, substance abuse treatment, injuries from felonies, and limitations on cost sharing for motorcycle accident-related injuries.
Prescription Drug Considerations
Note: While most Medicare Advantage plans include a prescription drug benefit, neither Medigap nor Medi-Share 65+ includes prescription drugs.
You should consider purchasing an additional Medicare Part D standalone plan in conjunction with your Medigap or Medi-Share 65+ plan.
The Medi-Share Statement of Faith
Medi-Share 65+ operates as a non-denominational Christian association with principles members are expected to uphold.
These principles include living by Biblical values, maintaining a healthy lifestyle, and adhering to the organization’s Statement of Faith.
Because it’s a faith-based organization, Medi-Share 65+ has some exclusions that don’t apply to Medigap or Medicare Advantage plans.
For example, Medi-Share 65+ will not share costs to treat drug or alcohol addiction, or to treat suicide attempts, injuries from deliberate self-harm, or injuries incurred as a drunk driver – even if only as a passenger.
Pre-Existing Conditions and Waiting Periods
Medi-Share 65+ offers favorable terms regarding pre-existing conditions.
During your initial Medicare eligibility period or the Medicare Fall Enrollment Period, waiting periods are waived. Even with pre-existing conditions, medical costs under Medicare Part A and Part B beyond $500 per year per household are fully shareable.
Outside of your Medicare initial eligibility or Fall Enrollment Period, the pre-existing waiting period for Medi-Share 65+ is only 6 months.
Some people keep a Medicare Advantage or Medicare Advantage plan in place for six months to cover pre-existing during the exclusion period, and then drop it once the six-month waiting period expires.
Can I Change My Medicare Plan?
If you’re contemplating a change in your Medicare plan, rest assured that options are available.
When you initially enroll in an Advantage plan, you have a 12-month window during which you can switch back to Original Medicare and add a Medigap plan.
If you have recently enrolled in a Medicare Advantage plan, but you’re unhappy with the care provided from doctors, clinics, and hospitals available to you within their network, contact a Personal Benefits Manager to discuss switching to a better plan.
Medicare Advantage Fall Enrollment Period
Additionally, there’s an annual Medicare Advantage enrollment period from October 15th to December 7th.
This is a limited annual window during which you can make changes to your Medicare Advantage coverage.
You can also apply for a Medigap plan at any time. But you may have to undergo medical underwriting.
You can also enroll in Medi-Share 65+ any time after you are age 65 or older and enrolled in Original Medicare (Parts A and B).
If you need individualized help, make an appointment with a Personal Benefits Manager for a free personal consultation.
Prescription Drug Coverage
Neither Medi-Share 65+ nor Medigap plans include prescription drug coverage.
If you opt for either plan while staying in Original Medicare, consider purchasing a standalone Medicare Part D prescription drug plan or explore Medicare Advantage plans with prescription drug coverage.
Get a Free Medicare Advantage Quote
Here’s a simplified comparison of the key differences with each of the three options that people use to protect themselves against high medical bills when on Medicare:
- Affordable health sharing alternative with a 10-year price lock-in guarantee
- Full sharing after meeting a $500 threshold
- Telehealth benefits and flexibility in choosing providers
- No prescription drug coverage
- Requires medical underwriting
- Access to renowned institutions like the Mayo Clinic and Cleveland Clinic
Medigap Plan G:
- Covers all out-of-pocket costs for Part A and B services
- Freedom to choose providers
- Guaranteed issue within six months of enrolling in Medicare Part B
- Premiums vary
- No prescription drug coverage
- No copays to providers
- No medical underwriting
- Managed care plans with network limitations (must choose a doctor within their network)
- Variable premiums
- Includes prescription drug coverage
- Enrollment during specific periods
- Co-pays and deductibles vary
- May require referrals for specialist visits
- Network limitations
Navigating Medicare options can be difficult and you may need assistance as your choice should align with your healthcare needs, budget, and personal preference.
We at MediGap Advisors are here to help!
For a free, personalized consultation, or help enrolling in a great plan that suits your individual needs and budget, make an appointment with one of our Personal Benefits Managers.
For Further Reading: Medicare Supplement and Medicare Advantage Plans: Which Are Better? | What Kind of Medicare Plan Is Best for Me? (Quiz) | The Less Expensive Medicare Supplement Alternative: Medi-Share 65+ | How to Get Out of a Bad Medicare Advantage Plan
Mike Montes is a Personal Benefits Manager at MediGap Advisors. Mike has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Mike on his Bio page.