Medicare Advantage vs. Medigap

Medicare Advantage plans are an alternative to Original Medicare. Sold by private insurers, these plans cover everything covered by Original Medicare but may also offer extra benefits for things that Medicare doesn’t. Additional benefits may include prescription drug coverage along with hearing, dental and vision care.

You can purchase a Medicare Advantage plan after enrolling in Medicare Part A hospital insurance and Medicare Part B medical insurance. When you enroll, your Medicare Advantage plan takes the place of your Medicare Part A and Part B coverage.

Medigap is intended simply to cover some of the gaps that Original Medicare doesn’t pay for — coinsurance, copayments and deductibles, for instance.

Original Medicare only pays 80% for Medicare-covered services such as your doctors’ services and any outpatient medical services and supplies. A Medigap plan can help cover some or all of that 20% gap that you have to pay for out-of-pocket.

Medigap cannot be used to pay for anything that Medicare Part A and Part B does not cover. This means you can’t use Medigap to cover prescription drugs or the hearing, vision and dental services that Original Medicare does not cover.

If you have Original Medicare and a Medigap policy, you may also benefit from a Medicare Part D prescription drug plan to help cover prescription drug costs.

With a Medigap plan, you have access to any doctor or provider who accepts Medicare. By contrast, you may have fewer choices in terms of doctors and health care providers with a Medicare Advantage plan.

Legally, you cannot have Medigap coverage with a Medicare Advantage plan. However, you may be able to switch between the two plans.

Biggest Differences Between Medicare Advantage and Medigap

Medicare Advantage and Medigap plans can provide different options to best suit your circumstances. You should compare Medicare plans carefully to make sure you’re getting the best coverage for your particular financial situation and health care needs.

If you are in good health with few medical expenses, Medicare Advantage can be a suitable and money-saving choice. But if you have serious medical conditions with expensive treatment and care costs, Medigap is generally better.

Speaking with a licensed insurance agent about your particular health situation can help you decide which is best for you. Since you are not allowed to have Medicare Advantage and Medigap at the same time, you have to choose carefully to make sure you have suitable coverage for your specific situation.

Weighing what options are most important to you and talking with a licensed insurance agent about your particular wants and needs can help you make an informed choice between Medicare Advantage and Medigap.

There are pros and cons for both Medigap and Medicare Advantage plans based on each individual’s financial situation and health circumstances.

You should compare the differences between the Medigap and Medicare Advantage plans you are considering before deciding which one you want to purchase.

Medicare Advantage plans usually have lower monthly premiums than Medigap plans. They may also include prescription drug coverage. You have to enroll in a separate drug plan if you go with Medigap.

If dental or vision coverage is important to you, you might choose Medicare Advantage because Medigap doesn’t help with these services. Medicare Advantage may also be better for you if you are flexible on which doctors you are willing to see, since you will have to use in-network health care providers to cut out-of-pocket costs.

One of the biggest disadvantages of a Medicare Advantage plan is that it limits your choice of doctors, hospitals and other health care providers. Medicare Advantage plans rely on health care provider networks — if you go to a doctor or other provider not in your network, you typically have to pay more of the cost.

While Original Medicare is the same across the United States, Medicare Advantage plans may only cover your health care in a specific area. If you move to a new state, you may have to replace your plan.

There are a wide variety of Medicare Advantage plans available — but they are not available in all areas. You may have a confusing number of Medicare Advantage plans to choose from if you live in a densely populated area, such as a major city. But you are more likely to have limited options in rural areas.

Medigap helps cover your out-of-pocket expenses if you decide to stick with Original Medicare.

The biggest advantage of Medigap may be your choice of doctors. You have more doctors and hospitals to choose from since you can go to any provider that accepts Medicare.

If your doctor is not in a Medicare Advantage plan you’re considering and you don’t want to switch doctors, you may want to consider Medigap. This will allow you to see any doctor who accepts Medicare.

While Medigap premiums are generally higher than those of Medicare Advantage, Medigap will likely charge you lower out-of-pocket expenses. You’ll need to calculate how much you expect to pay for health care over a year and compare that to your annual premium cost.

Finding a Medigap plan that works for you can be less confusing because there are only eight types to choose from. This can simplify enrolling in Medicare.

Costs are the leading disadvantage of Medigap. Medigap plans tend to have higher monthly premiums than Medicare Advantage plans. You also still have to pay your Medicare Part B monthly premiums.

If you didn’t become eligible for Medicare before January 1, 2020, Medigap can no longer pay for your Medicare Part B deductible.

To be eligible for a Medigap plan, you have to be 65 years or older and be enrolled in both Medicare Part A hospital insurance and Medicare Part B medical insurance.

You are not guaranteed that your application for a Medigap policy will be accepted if you don’t purchase a plan when you are first eligible for Medicare. Even if you are accepted after the initial enrollment period, you may have to pay more for a Medigap policy.

Medigap policies are standardized in 47 states and the District of Columbia. But costs may vary state-to-state for the same plan.

If you originally sign up for Medicare Advantage and decide it isn’t right for you, you can switch to Medigap supplemental coverage. You can also switch from Medigap to a Medicare Advantage plan.

However, you have to follow certain rules and there may be some problems if you decide to switch down the line.

If you are in a Medicare Advantage plan, you can make a switch to a different Medicare Advantage plan during Medicare’s open enrollment period, which runs from October 15 through December 7 each year.

You may also not be able to get a Medigap policy if you give up your Medicare Advantage plan. If you are new to Medicare, insurers are required to sell you a Medigap policy. But after that initial enrollment, there’s no guarantee that they will sell you one.

Insurers can also charge you more for a Medigap policy if you have serious medical problems when you decide to switch from a Medicare Advantage plan.

A handful of states protect your ability to switch back to Original Medicare with Medigap coverage.

Rules guaranteeing your ability to switch vary between each of these states. You should check with your state’s rules to determine what applies in your case.

There are several questions you can ask yourself to help narrow down whether Medigap or Medicare Advantage might be a better fit for you.

If you’re considering Medicare Advantage, these are some questions you should ask yourself.

If you answered “Yes” to the majority of these questions, you may want to focus mainly on Medicare Advantage plans.

You may want to ask yourself the following questions if you are considering a Medigap plan.

If you answered “Yes” to a majority of these questions, you may want to learn more about Medigap options.

When making a decision, it’s important to consider your financial situation and the quality of your health. Talking with a Medicare advisor can help guide you to a clearer understanding of what type of Medicare coverage is best for you.