What Are the Differences Between Medigap and Medicare Advantage?
Medicare, unfortunately, offers no limit on your maximum out-of-pocket expenses if you need medical care.
This is where Medicare supplement plans, or Medigap, and Medicare Advantage plans come in. Both provide a way to obtain or supplement your Medicare benefits to protect you from high medical bills and limit your out-of-pocket medical expenses, but they work very differently.
If you’re like the thousands who visit our site each month looking for Medicare coverage, you may wonder how Medigap and Medicare Advantage stack up. Here, we compare the two side-by-side so you can make more informed healthcare choices.
What are Medicare Advantage Plans
Medicare Advantage plans are a way to get your Medicare from a private insurer in place of your original Medicare. The tremendous advantage over original Medicare is that a Medicare Advantage plan will limit your maximum out-of-pocket exposure, which original Medicare does not.
Medicare Advantage is required to offer the same level of coverage as Medicare, and some of these plans may include vision, dental or hearing coverage.
What are Medicare Supplement Plans
Medicare supplement plans are also called “Medigap”, and pay the charges that original Medicare does not. This can include deductibles and copays, so that virtually all of your charges may be covered, leaving you with little left to pay out of your own pocket.
Key Considerations When Choosing Between Medigap or Medicare Advantage
Did you know it is illegal for any insurance company to sell you both a Medigap and Medicare Advantage policy? Therefore, it is important to know the differences before taking the plunge.
Ask yourself the following questions:
- Do you travel often? Most Medicare Advantage plans are specific to one area. Should you live in different climates throughout the year, traditional Medicare plus Medigap is probably a better choice than an Advantage plan. This may also be true if you travel frequently; some Medigap plans provide coverage when traveling outside of the United States and cover you in all 50 states; Advantage plans generally do not.
- Is choice of doctors important? If you don’t want to be restricted to a specific doctor network, Medigap may suit you better. Medigap plans will cover any doctor that accepts Medicare, and referrals aren’t necessary to see specialists.Advantage plans, on the other hand, have their own networks, and you may not be covered if you see a doctor who is out of your network.
- Do you want to keep your monthly premiums low?. Medigap coverage typically has a much higher monthly premium but could result in lower out-of-pocket expenses than some Medicare Advantage plans. Medicare Advantage plans, on the other hand, generally cost less (often with a $0 premium).
- Are you more concerned with out-of-pocket costs? Medigap covers expenses that Original Medicare does not pay, like copayments, coinsurance, and deductibles, leaving you with little out-of-pocket costs; however, these plans tend to cost more.
With Advantage, you’ll have to pay copays and coinsurance – but at least Advantage plans do cap out-of-pocket exposure to no more than $6700, which Original Medicare does not.
- When is enrollment? In order to get guaranteed enrollment in a Medigap plan, you have to sign up either within six months of enrolling in Original Medicare or within six months of turning 65 if you’re already enrolled in Medicare.After your initial enrollment period, you can enroll in a Medigap plan at any time, but you will have to answer some health questions to qualify.Your initial enrollment period for a Medicare Advantage plan starts in the third month prior to the month you turn 65, and ends 3 months after the month you turn 65. There is also an Annual Election Period every year that you can get guaranteed acceptance in a Medicare Advantage plan, lasting from October 15 – December 7.
- Do you need extra coverage? If you’re someone who needs prescription, dental, vision, or hearing coverage, it might make more sense to go with an Advantage plan. Medigap typically doesn’t cover these services, but Advantage plans often do.If you go with a Medigap plan, you’ll probably want to add a separate Medicare Part D plan to help pay for prescriptions.
Things to keep in mind
It’s important to note that for both Medigap and Medicare Advantage plans, you have to continue paying Medicare Part B premiums. One considerable selling point for both Medigap and Medicare Advantage is what they protect. If you wish to avoid a huge bill for health costs Medicare doesn’t cover, either plan will help lower those bills.
If you are ok with higher monthly premiums, want very low out-of-pocket costs, no restrictive networks, the ability to see specialists without a referral and the ability to travel and still have coverage, a Medigap plan might best suit you.
If you want lower premiums, are ok with higher out-of-pocket costs and just using network doctors, and would like something that includes prescription and dental, a Medicare Advantage plan might best suit you.
Remember, healthcare is not one-size-fits-all. This is an individual choice, and there is no right or wrong decision for everyone.
Regardless of which plan you choose, you can enroll with your Personal Benefits Manager (PBM) here at Medigap Advisors. If you’re still unsure of which would work best for you, we’ll walk you through the process.
Call us today to get started with either Medicare Advantage or Medigap coverage.