Turning 65 means making important healthcare choices like choosing between Medicare Advantage vs Medicare Supplement.
Both options offer different benefits and trade-offs. The right choice depends on your budget, lifestyle, and medical needs.
In this guide, we compare Medicare Advantage vs Medicare Supplement plans to help you make an informed decision. We also discuss Medi-Share 65+, a health-sharing alternative for those looking for another option.
What Are Medicare Advantage and Medicare Supplement Plans?
When deciding between Medicare Advantage vs Medicare Supplement, it’s important to know how they differ.
Both help with healthcare costs, but they work in separate ways.
- Medicare Supplement (Medigap): Works alongside Original Medicare, covering out-of-pocket costs like deductibles and copayments.
- Medicare Advantage (Part C): Replaces Original Medicare with a private, all-in-one plan that often includes extra benefits like prescription drug coverage, dental, and vision.
You can’t have both at the same time, it’s one or the other. If you switch from one to the other, you should drop your old plan once the new one takes effect.
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Medicare Advantage: Pros and Cons
Medicare Advantage (Part C) offers an alternative to Original Medicare, combining hospital, medical, and often prescription drug coverage into one plan.
While these plans come with several benefits, they also have some trade-offs.
Pros of Medicare Advantage
All-in-One Coverage: Most plans bundle hospital (Part A), medical (Part B), and prescription drug coverage (Part D) into a single policy, simplifying your healthcare management. Medigap plans don’t include drug coverage, you have to buy a separate Part D plan.
Extra Benefits: Many Medicare Advantage plans include perks Original Medicare doesn’t cover, such as vision, dental, hearing, and even gym memberships. Some plans go further, offering non-medical benefits like personal assistance, meal deliveries, and transportation.
Lower Monthly Costs: In many areas, you can find Medicare Advantage plans with low or even zero-dollar monthly premiums.
Out-of-Pocket Maximum: Unlike Original Medicare, Medicare Advantage plans cap your yearly healthcare expenses, protecting you from unexpected high medical costs.
Specialized Plans: Special Needs Plans are available for people with chronic conditions, those in institutional care, or individuals eligible for both Medicare and Medicaid. Medigap does not offer a comparable option.
Medical Savings Accounts (MSAs): Some plans include an MSA, a tax-free savings account funded by your Medicare Advantage plan. You can use these funds for healthcare expenses, including long-term care insurance premiums.
Cons of Medicare Advantage
Provider Restrictions: Most Medicare Advantage plans operate as HMOs or PPOs, meaning you’ll need to use in-network doctors and hospitals to get full benefits. Seeing an out-of-network provider may result in higher costs.
Referral Requirements: If you enroll in an HMO plan, you may need a referral from your primary doctor before seeing a specialist, adding an extra step to your care.
Limited Coverage When Traveling: Many Medicare Advantage plans focus on regional provider networks, which can be a challenge if you travel frequently or live in multiple states.
Who Should Join Medicare Advantage?
Medicare Advantage may suit you if:
- You prefer an all-in-one solution.
- You want or need supplemental benefits particularly suited to your medical situation, such as meal assistance and transportation.
- You don’t mind having restrictions on your ability to choose your own doctor
- You want extra benefits like vision and dental coverage.
- You want prescription drug benefits included in your plan and the drugs you need are included in your plan’s formulary.
- You’re looking for lower monthly premiums, or no premium at all.
- You do not plan to do much traveling outside the U.S.
- You don’t plan on traveling much outside your network area.
Medigap plans could be better for you if:
- You can afford the premiums
- You want the flexibility to choose your own doctors, clinics, or hospitals without having to worry about whether they are in your plan’s network.
- You frequently travel out of states.
- You plan to travel outside of the U.S.
- You don’t want to be in an HMO or PPO.
- You don’t mind buying a separate Medicare Part D policy to cover prescription drugs
- You prefer a plan that makes healthcare costs more predictable.
The Medi-Share 65+: A Health Sharing Alternative
If you are looking for a faith-based alternative to Medicare Supplement insurance, Medi-Share 65+ might be worth considering.
This Christian health sharing plan helps Medicare beneficiaries cover medical expenses by pooling contributions with other members.
Although Medi-Share 65+ is not insurance, it works similarly to Medigap by covering costs that Original Medicare doesn’t pay.
How Medi-Share 65+ Works
- You pay the first $500 per household in eligible expenses each year.
- After that, Medi-Share members cover the rest of your Medicare-approved costs, including deductibles and copays.
- Monthly contributions are lower than most Medigap premiums, especially in higher-cost areas.
Current Costs:
- Ages 65-74: $99 per month
- Ages 75+: $150 per month
Pros of Medi-Share 65+
Community-Based Support: Members contribute toward each other’s medical costs, creating a faith-driven healthcare solution.
Lower Monthly Costs: Contributions are often more affordable than Medigap premiums.
No Network Restrictions: You can see any doctor who accepts Medicare, with no in-network or out-of-network limits.
Overseas Benefits: Unlike Medicare Advantage, Medi-Share 65+ covers some medical expenses outside the U.S. (with certain limits).
Cons of Medi-Share 65+
Not Insurance: Because it’s a sharing program, it doesn’t offer the same protections as traditional insurance.
Eligibility Requirements: Members must meet faith-based and lifestyle guidelines, which may limit participation.
Limited Coverage: Some expenses, like drug and alcohol treatment, are not shareable. Check the Medi-Share 65+ guidelines for exclusions.
Who Should Consider Medi-Share 65+?
- Christians who prefer a faith-based, community-driven approach to healthcare.
- Budget-conscious individuals who want Medigap-like coverage at a lower cost.
- Seniors who travel and want a plan that covers out-of-network providers or overseas care.
If you meet the eligibility criteria and want a lower-cost alternative to Medigap, Medi-Share 65+ could be a good fit.
👉 Get an instant quote and explore Medi-Share 65+ today!
Medicare Advantage vs Medicare Supplement: Making the Right Choice
Choosing between Medicare Advantage, Medigap, or Medi-Share 65+ comes down to what works best for your lifestyle and budget.
If you want an all-in-one plan with added benefits, Medicare Advantage could be a good fit. If flexibility and predictable costs matter most, Medigap might be the better option.
If you are seeking a lower-cost, faith-based alternative, Medi-Share 65+ offers a unique approach to sharing medical expenses.
Since healthcare decisions can be complex, speaking with a Personal Benefits Manager can help you compare your options and make an informed choice. Schedule a consultation today to find the right plan for your needs.
For Further Reading:
- What Kind of Medicare Plan Is Best for Me? (Quiz)
- How People on Medicare can Protect Themselves Against the Financial Risk of Cancer
- Medigap High-Deductible Plan G Review
- Learn Your Medigap ABCs – Comparing The Top Medicare Supplement Insurance Plans in 2024
Here are some additional pages related to this article:
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Medicare Supplement and Medicare Advantage FAQs
What are the different parts of Medicare, and what do they cover?
Medicare has four parts:
- Part A: Hospital insurance covering inpatient care, skilled nursing facility care, and some home healthcare services.
- Part B: Medical insurance covering outpatient services, doctor visits, preventive care, and durable medical equipment.
- Part C: Medicare Advantage plans offered by private insurers, combining Part A and Part B coverage, often with additional benefits.
- Part D: Prescription drug coverage, available as stand-alone plans or included in some Medicare Advantage plans.
Parts A and B together are sometimes referred to as Original Medicare.
MediGap plans don’t include Part D benefits. You would need to buy a separate standalone policy.
Most Medicare Advantage plans include prescription drug benefits, but not all of them do.
What is the cost of Medicare Part A, and who qualifies for premium-free Part A?
Most people do not pay a premium for Medicare Part A if they or their spouse have paid Medicare taxes for at least 10 years (40 quarters).
For those who don’t qualify for premium-free Part A, the cost depends on their work history.
When should I enroll in Medicare, and what happens if I miss my Initial Enrollment Period (IEP)?
Your Initial Enrollment Period (IEP) begins three months before your 65th birthday month and ends three months after it.
Missing your IEP may result in late enrollment penalties for Part B and Part D, and delayed coverage.
What is MediGap, and how does it work with Medicare?
MediGap, also known as Medicare Supplement insurance, helps cover out-of-pocket costs like copayments and deductibles that Original Medicare doesn’t pay. It works alongside your Medicare coverage, providing additional financial protection.
Can I switch from Medicare Advantage to Original Medicare with a MediGap plan?
You can switch from a Medicare Advantage plan to Original Medicare and enroll in a MediGap plan during specific enrollment periods.
However, you may be subject to medical underwriting or availability restrictions with your new MediGap plan. That means enrollment is not guaranteed, or you could be charged a higher premium due to your medical history.
Are preventive services covered under Medicare?
Yes, Medicare Part B covers many preventive services, including flu shots, screenings, and counseling.
Most preventive services are provided at no cost to you, provided your healthcare provider accepts assignment.
Can I have both Medicare and Medicaid coverage?
Yes, you can.
Individuals qualify for both Medicare and Medicaid. This is called “dual eligibility.”
Medicaid helps cover Medicare premiums, copayments, and other healthcare costs for those with limited income and resources.
Can I make changes to my Medicare Advantage or Part D plan during the Fall Annual Enrollment Period (AEP)?
Yes, you can.
You can make these changes during the Fall Annual Enrollment Period (AEP), you can make changes to your Medicare Advantage or Part D plan, such as switching plans or enrolling in a new one.
The AEP typically runs from October 15th to December 7th each year.
Click here to learn more about your options during Medicare Fall Open Enrollment.
Where can I find assistance and resources for understanding and navigating Medicare?
You can find assistance through various sources, including the official Medicare website (Medicare.gov), State Health Insurance Assistance Programs (SHIP), local Area Agencies on Aging, and certified insurance agents who specialize in Medicare.
These resources provide guidance on enrollment, plan selection, and understanding your Medicare options.
If you need help choosing or signing up for a MediGap plan, a Medicare Advantage Plan, or the Medi-Share 65+ Health Sharing plan, or if you need to get long-term care or life insurance in place to protect you and your family during your retirement years, click here to schedule a free consultation.
Tom Lockwood is a Personal Benefits Manager at MediGap Advisors. Tom 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 Tom on his Bio page.