You’re in the right place: There are a lot of different factors to consider. But narrowing down your options is easier than you think.
When you enroll in Medicare, you generally have four main options to choose from: Medicare Advantage, Medigap (also known as Medicare supplement insurance), and a great but lesser-known option called the Medi-Share 65+ health sharing plan.
Each of these options has advantages and disadvantages. But once you narrow down which of these basic approaches may be best for you, it’s much easier to research your options and make an informed choice.
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TAKE THE QUIZ
Question 1: Do you frequently visit specialists for your healthcare needs?
- If you answered YES, then: A Medigap plan may be ideal for you as it offers broader access to specialists without requiring a referral.
- If you answered NO, then: Consider a Medicare Advantage plan that typically uses a network of doctors and could be more cost-effective if you don’t need to see specialists often.
Question 2: Are you looking for a low-cost alternative to traditional Medicare plans?
- If you answered YES, then: Consider Medi-Share 65+, a health sharing plan that tends to be more budget-friendly compared to the more comprehensive Medigap policies like Plan G, F, C, and N.Note: Medi-Share 65+ is not a health insurance plan. Instead, it’s a health sharing plan, which is an alternative to health insurance. It’s not regulated the same way as Medigap and Medicare Advantage plans. Instead, it’s a voluntary association of thousands of like-minded individuals who have agreed to help share one another’s medical costs.
- If you answered NO, then: Either Medigap or Medicare Advantage could work for you based on your specific healthcare needs.
Question 3: Do you travel frequently within the United States?
- If you answered YES, then: A Medigap plan could be a better fit, offering more flexibility in choosing healthcare providers across the nation.
- If you answered NO, then: A Medicare Advantage plan, which generally operates within a local or regional provider network, might be sufficient for you.
Question 4: Are you comfortable with a high level of cost-sharing for a lower monthly premium?
- If you answered YES, then: Medi-Share 65+ could be a good option, offering a lower cost but with more financial responsibility for healthcare expenses. However, even with Medi-Share 65+, your household out-of-pocket costs for Medicare Part A and B-approved costs is limited to just $500 per month. That’s for your whole household.
- If you answered NO, then: A Medigap Plan G or Plan N policy may be more suitable for you. These generally have higher monthly premiums than the Medi-Share 65+ health sharing plan. But with Plan G and Plan N, your share of Part A and Part B costs is limited to your Medicare Part B deductible, which is just $216 in 2023.Plan G is best if your state allows your doctor to charge excess fees over and above what Medicare covers. Plan N works better in states that don’t allow excess charges.
Question 5: Do you require prescription drug coverage?
- If you answered YES, then: Medicare Advantage plans often include prescription drug coverage, making it a one-stop-shop for all your healthcare needs.
- If you answered NO, then: You may find better value in a Medigap or Medi-Share 65+ plan, which often do not include prescription coverage, potentially making them more cost-effective for you. However, it’s easy to buy a standalone Part D prescription drug plan, which can work alongside your Medigap or Medi-Share 65+ health sharing plan.
Question 6. Are you looking for additional benefits like vision, dental, and hearing?
- If you answered YES, then: Medicare Advantage often includes these additional benefits.
- If you answered NO, then: You may prefer the flexibility of a Medigap plan or the lower cost of Medi-Share 65+.
Question 7: Is faith-based cost-sharing in line with your personal beliefs?
- If you answered YES, then: Medi-Share 65+ could be a great match, aligning with your faith-based approach to healthcare cost-sharing.
- If you answered NO, then: You’ll likely feel more comfortable with a Medigap or Medicare Advantage plan.
Question 8: Are you on a very tight budget and need the lowest-cost plan available?
- If you answered YES, then: You should consider a Medicare Advantage plan. In most markets, there are one or more plans available with a zero premium. There are some other Medicare Advantage plans that have very low premiums, but not zero. The next best option if you’re on a shoestring budget but want more freedom to choose your own doctor is the Medi-Share 65+ plan, which starts at just $99 per month if you are aged 65 to 75.
- If you answered NO, then: You may consider either the Medi-Share 65+ health sharing plan, or one of the more comprehensive Medigap plans, such as Plan G or Plan N.
Question 9: Do you plan on traveling abroad during your retirement?
- If you answered YES: then a Medigap plan may be best for you. Some but not all Medigap plan tiers provide benefits if you need care while traveling outside the U.S., up to a lifetime benefit cap of $50,000. If you want a higher limit the Medi-Share 65+ health sharing plan may be a good match. Medi-Share 65+ also helps share costs for needed medical services while traveling outside the United States, but with a much higher lifetime sharing cap of $150,000.See the details here: Does Medi-Share 65+ Pay When Traveling Outside the U.S.?
- If you answered NO: then Medicare Advantage may be a better fit. Medicare Advantage plans typically rely on local care networks, and restrict non-emergency care out of network. They typically don’t cover care from providers outside the U.S.
Question 10. Do you have a specific chronic medical condition that requires ongoing management?
- If you answered YES: Contact a Medigap Advisors Personal Benefits manager and ask them to help you research a plan designed specifically for your medical condition. Some Medicare Advantage plans provide more focused care for people with certain chronic medical conditions.
- If you answered NO: Then you might be better suited for a Medigap or Medi-Share 65+ health sharing plan that provides more flexibility when it comes to choosing your own doctors and other providers.
Question 11: Do you live in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont?
- If you answered YES: Your state does not allow Medicare “excess charges.” That means that your doctor cannot bill you additional charges over and above the Medicare authorized rate for that medical service or procedure. If you live in these states, and you want to buy a comprehensive Medigap plan, you may save money by buying a Plan N rather than a Plan G.
Both Plan N and Plan G pay for all Medicare Part A and Part B standard charges, except for your Part B deductible, which is $216 per year as of 2023.
The difference is Plan G also pays physician’s excess charges. If you have Plan N, those excess charges are your responsibility.
While Plan G pays for excess charges, you have to pay a slightly higher premium for it. If you’re in one of these states, you won’t get any value for that additional premium. Instead, consider buying a Plan N to save a few dollars.
- If you answered NO: You may be better off in a Plan G rather than a Plan N. Plan G pays for Medicare excess charges, where Plan N does not. If you own Plan G, you don’t have to worry about any excess charges. This also means you can see the top doctors available in your state. Your Medigap Plan G will cover all your physician’s charges, even if they charge well above the Medicare reimbursement rate. If you chose Plan N, and you’re not in one of the eight states that prohibit excess charges, you will have to pay your doctor’s excess charges out of your own resources.
Advantages and Disadvantages of Each Plan Type
- Advantages: Greater flexibility in choosing healthcare providers, fewer referrals needed, and generally lower out-of-pocket costs.
- Disadvantages: Higher monthly premiums, usually no additional benefits like dental or vision, and no prescription drug coverage.
- Advantages: All-in-one plans often include prescription drug coverage, vision, dental, and hearing.They often have lower premiums and set co-payments, making healthcare costs more predictable. In most areas, there’s a zero-premium option available.Many areas also have access to Medicare Advantage MSA plans, or Medical Savings Accounts.With these plans – generally available at a zero premium – your insurance carrier will deposit a set amount of money in a special tax-free account each year for you to use to pay Medicare deductibles, co-pays, and other out-of-pocket costs.In concept, it’s similar to a health savings account, except you can’t contribute your own money.If you liked the concept of health savings accounts, and you’re used to managing your own money when it comes to your medical expenditures, a Medicare MSA plan may be a great match.Click here to learn more about Medicare MSAs, or contact a Medigap Advisors Personal Benefits Manager for a free personal analysis, recommendation, and quote.
- Disadvantages: Medicare Advantage plans Usually operate within a network, meaning less flexibility in choosing healthcare providers. They might also require referrals to see specialists.
- Advantages: Lower monthly costs compared to its closest competitors, Medigap Plans G and N. High level of cost-sharing reduces premiums. The plan also aligns with faith-based principles.Members have great flexibility to choose their own doctor. There are no limited care networks as there are in Medicare Advantage plans.
You can sign up for Medi-Share 65+ at any time. There are no open enrollment periods or limited enrollment periods to worry about. However, it’s best to enroll in Medi-Share 65+ as soon as you’re eligible for Medicare.
- Disadvantages: You may have to pay up to $500 in Medicare Part A and B-covered costs before the Medi-Share 65+ plans’ sharing benefits kick in.Does not share costs for some medical needs, including drug and alcohol addictions treatment, or costs related to drunk driving accidents – even if you’re only a passenger in a vehicle driven by an intoxicated person.
Remember, everyone’s situation is different. The right choice for you may not be the same for someone else.
For a free, personalized consultation, analysis and quote, click here, and make an appointment with one of our highly-experienced Personal Benefits Advisors.
Here are some additional blogs on the topic: Can I Change or Switch My Medigap Plan?| The Less Expensive Medicare Supplement Alternative: Medi-Share 65+
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Frequently Asked Questions
What is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare (Part A and Part B).
It combines hospital, medical, and often prescription drug coverage and may offer additional benefits such as dental and vision.
How do I enroll in a Medicare Advantage Plan?
You can enroll during your Initial Enrollment Period when you first become eligible for Medicare or during the Annual Election Period (Oct 15 – Dec 7).
You can sign up online, by mail, or through a licensed insurance agent.
Are there any prerequisites for enrolling in Medicare Advantage?
You must be enrolled in Medicare Part A and Part B to qualify for Medicare Advantage. You also need to live in the plan’s service area.
Is a prescription drug plan included?
Most but not all Medicare Advantage plans include a prescription drug plan.
Medigap and Medi-Share 65+ do not. You would need to add a Medicare Part D prescription drug plan to work alongside either of these plans.
If you choose a Medicare Advantage plan that does not have a built-in Rx plan, you should also consider adding a Medicare Part D plan on top of it.
Otherwise you will not be covered for prescription drugs.
Can I see any doctor I want?
Not with Medicare Advantage plans.
These plans are managed care organizations (HMOs, PPOs, and EPOs) that generally require you to see doctors in a specific network. HMOs also require a referral before the plan will pay for you to see a specialist.
PPO plans also impose care networks, but don’t require your primary care provider to refer you to a specialist. You can see a specialist without a PCP referral.
PCPs offer more flexibility, but also cost more than HMOs.
However, if having a lot of freedom to choose your own doctor is important to you, you should consider either a Medigap plan or the Medi-Share 65+ health sharing plan.
What is Medigap?
Medigap, also called “Medicare supplement insurance,” is a private insurance policy that can be added to Original Medicare (Part A and Part B) to cover gaps in coverage like co-payments, deductibles, and other out-of-pocket expenses.
How do I enroll in a Medigap plan?
You can buy a Medigap policy from a private insurance company.
The best time to buy is during your 6-month Medigap Open Enrollment Period, which starts the month you’re 65 or older and enrolled in Part B.
Can I have both Medigap and Medicare Advantage?
No, you can’t have both. If you have a Medicare Advantage plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare.
Are prescription drugs covered under Medigap?
No, Medigap plans don’t cover prescription drugs.
You would need to enroll in a Medicare Part D plan for that.
Is Medigap standardized?
Yes, Medigap plans are standardized and identified by letters A through N, but they are offered by private companies which can set their own premiums.
Three states have slightly different standardized plans than the rest of the country: Massachusetts, Minnesota, and Wisconsin.
What is Medi-Share 65+?
Medi-Share 65+ is a health sharing plan and not insurance. Members share each other’s eligible medical bills based on their shared beliefs.
How do I enroll in Medi-Share 65+?
You can self-enroll in Medi-Share 65+ in minutes by clicking here and following the instructions on the page.
If you hit a snag, or need personalized assistance at any time, we’re more than happy to help! Click here to set an appointment for a FREE consultation with a Personal Benefits Manager.
Note that there may be a statement of faith requirement and lifestyle guidelines.
Is Medi-Share 65+ a replacement for Medicare?
No, Medi-Share 65+ is meant to work in conjunction with Medicare.
You’ll still be enrolled in Original Medicare (Parts A and B), just as you would be with a Medigap plan. Medi-Share 65+ just steps in to help you pay all but the first $500 of your household’s out-of-pocket Part A and B charges per year.
Once you and Medi-Share 65+ combine to pay all your Part A and Part B premiums, deductibles and copays, then Medicare Parts A and B kick in after that.
Does Medi-Share 65+ cover prescription drugs?
Medi-Share 65+ does not provide comprehensive coverage for prescription medications.
If you want prescription drug coverage, you should add a Medicare Part D plan to work alongside your Medi-Share 65+ health share plan, or consider a Medicare Advantage plan that includes prescription drug coverage.
Need help deciding? Click here to schedule a free consultation with a Personal Benefits manager.
Are there any network restrictions with Medi-Share 65+?
Generally, Medi-Share 65+ allows you to see any provider that accepts Medicare patients.
There are no limited networks of authorized providers.
This distinguishes Medi-Share 65+ as well as Medigap plans from Medicare Advantage plans, which do have limited provider networks.
Remember to consult with healthcare professionals and advisors to make the most informed decisions about your healthcare coverage options.
It contains everything you need to know to choose between Medicare Advantage, Medigap, and the Medi-Share 65+ health sharing plan.
It also has links for you to get a free quote for the plan of your choice.
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage.