Fussell & Goodyear explains how Medigap differs from Medicare Advantage

What’s the Difference Between Medigap and Medicare Advantage?

It’s fairly common to confuse Medigap insurance (Medicare Supplements) with Medicare Advantage, but there are many differences between the two. And you must pick one or the other. A Medigap policy will likely have different costs, coverage, network requirements, and enrollment periods than an Advantage plan. Let’s take a closer look. 

What Are Medicare Supplements?

Medicare Supplements are health plans that help fill in the gaps that Original Medicare leaves behind, such as deductibles and coinsurance. A Medigap policy adds to your A and B benefits, hence the name “supplements.” There are 10 standardized plans available in most states, lettered A through N, and some carriers offer high deductible versions of F and G.

Related Post: How Do Medicare Supplements Work?

What Is Medicare Advantage?

Medicare Advantage (Part C) is an alternative to Original Medicare — offering the same benefits as A and B, and may include additional coverage like dental, vision, and hearing. There are several types of Advantage plans, including HMO, PPO, PFFS, SNP, and more. 

If you have an Advantage plan and your situation changes, you can always return to Original Medicare during the annual enrollment period (AEP). 

Related Post: What Are Private-Fee-for-Service Plans?

How Are They Similar?

Both Medicare Supplements and Medicare Advantage plans are offered by private, Medicare-approved insurance companies. With either choice, you continue paying the monthly premium for Part B to Medicare, which is $148.50 in 2021. 

How Are They Different?

The table below shows how they differ:

  Medigap Policies Medicare Advantage Plans
Costs? You pay a monthly premium, plus your Part B premium. Out-of-pocket costs are limited. Usually, you pay a low or $0 monthly premium in addition to your Part B premium. You pay deductibles, copays, and coinsurance, but all plans have a maximum out-of-pocket amount before your medical costs are paid for. 
Doctors and Hospitals? You can choose them as long as they accept Medicare patients! You’ll likely need to use providers in the plan’s network, or you’ll pay more for services.
Referrals? Not required to see a specialist. You may need them.
Network? No limitations. Nationwide coverage. Typically, there’s a limited-service area unless it’s an emergency. 
When to Enroll? Any time after you turn 65 and enroll in Part B. Limited to certain times. The open enrollment period is January 1 to March 31.
Prescription Drug Coverage? No. Consider buying a stand-alone Part D plan. Most have it built-in, called MA-PD plans.

Some Tips to Help You Decide

When choosing between a Medigap policy or a Medicare Advantage plan, consider these questions:

  1. Do you want the freedom to select your provider, or are you alright with selecting one from the plan’s network?
  2. Would you rather purchase a stand-alone Part D plan or get prescription drug coverage included in one program?
  3. Would you prefer to pay higher monthly premiums and have lower out-of-pocket costs for healthcare or pay a low (or $0) premium but potentially more out-of-pocket expenses and copays?

FREE Medicare Help Is Available!

Deciding whether a Medicare Supplement plan or Advantage plan is best for you is only the first step. Then, you have many policies and plans to explore under those. The vast options can seem overwhelming, but Fussell & Goodyear can make it easy. For FREE Medicare help, call 1-877-874-0711 or send an email to Office@Fgiala.com.