A man’s feet stand in front of arrows pointing in three directions, symbolizing choices between Medigap versus Medicare Advantage plans.

Comparison shopping between healthcare plans, such as Medigap versus Medicare Advantage, can be quite confusing. After reviewing each plan, you may still be uncertain about their differences. In order to understand which plan is right for you, you need to understand what each plan has to offer first.

What’s the Difference Between Medigap and Medicare Advantage?

Private insurance companies work with both Medigap plans and Medicare Advantage plans to take care of the many out-of-pocket costs that your original Medicare plan doesn’t cover. Keep in mind that standardized care and costs differ between the two plans, which should be taken into account when considering Medigap versus Medicare Advantage.

Medigap Plans, Also Called Medicare Supplement Insurance:

  • Are standardized, meaning your benefits will be the same no matter which insurance company you choose
  • Are standardized differently in Massachusetts, Minnesota, and Wisconsin
  • Cover more out-of-pocket expenses, such as copays, once the Original Medicare deductible is met
  • Have higher monthly premiums than Medicare Advantage plans
  • Require a Medicare Part D plan for prescription drug coverage
  • Are guaranteed issue within the first six months after turning 65
  • Let you choose who to see—there are no networks to consider, referrals required, or service areas to stay within
  • Must be used with Original Medicare, Parts A and B, and cannot be used along with Medicare Advantage
  • Do not normally cover vision, dental, hearing, private nursing, or long term care

Insurance companies offer an array of Medigap plans named for letters of the alphabet. The range of plans available varies by state, but plans with the same letter name must offer the same standardized benefits. Some plans may offer additional coverage. To learn the basics of each Medigap plan, take a look at this Medigap breakdown from HealthMarkets.

Medicare Advantage plans:

  • Vary among insurance companies but must cover all the services of Original Medicare⃰
  • Generally provide hospital coverage, doctor visits, and prescription drugs under one plan
  • May offer extras, such as vision, hearing, or dental coverage
  • Have a yearly out-of-pocket spending maximum ($6,700 in 2017) after which your out-of-pocket costs are zero
  • May require signing up during open enrollment
  • Can be used in place of Original Medicare, and cannot be used along with Medigap
  • Are available to people with pre-existing conditions, except those with End-Stage Renal Disease (ESRD)

Just over a third of people with Original Medicare also choose to use a Medicare Advantage plan, and it’s easy to see why. These plans combine Parts A and B with most plans including prescription coverage—and sometimes additional benefits—and they could cost less than most Medigap plans.

However, because Medicare Advantage plans come from different companies, they might restrict you to a network or require a referral for certain services. Medigap plans tend to offer more freedom to see the doctors you want when you want without needing a referral. Statistically, the number of people who choose Medigap isn’t far behind those who choose Medicare Advantage—20% of Medicare beneficiaries use a Medigap plan.

We know that Medigap versus Medicare Advantage can be a confusing decision to make. There’s no right answer for everyone, but there is a plan that’s right for you. The licensed insurance agents at HealthMarkets are available in person and by phone to provide the personalized assistance you need to make the best decision. We want to be your healthcare resource, and it is our mission to make insurance shopping easy. That way you can focus on the important things in life. Get in touch with HealthMarkets by calling (800) 488-7621 or searching for a local agent today.

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References

Medicare Advantage plans are not required to cover hospice care, but Original Medicare will cover it even if you have an Advantage plan.

https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html | https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html | https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html | http://www.consumerreports.org/cro/news/2014/10/medigap-vs-medicare-advantage-consumer-reports/index.htm | https://www.medicare.gov/what-medicare-covers/medicare-health-plans/medicare-advantage-plans-cover-all-medicare-services.html | https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html | https://www.youtube.com/watch?v=BUpq8HyxWRw | http://kff.org/medicare/fact-sheet/medicare-advantage/ | https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/things-to-know-medicare-advantage-plans.html | https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf | http://kff.org/medicare/perspective/the-gap-in-medigap/

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