Medigap vs. Advantage

What is a Supplement (Medigap) policy?

Medigap is a supplement insurance that helps fill “gaps” in the Original Medicare policy and is sold by private companies.  Because the Original Medicare doesn’t cover all of the cost for covered health care services and supplies, a Medigap policy can help pay some of the remaining health care costs, like:

  • Co-payments
  • Coinsurance
  • Deductibles

Some details:

  • Must have parts A & B to have a Medigap policy
  • Private insurance to fill in the “gaps” in Original Medicare coverage
  • Pays some costs that Original Medicare doesn’t (like co-payments, coinsurance, and deductibles)
  • Federally standardized plans identified by letters A -N
  • Guaranteed renewable even if you have health problems, as long as the premiums are paid
  • You cannot have a Medigap policy and Advantage plan at the same time
  • All policies will have the same benefits no matter which insurance company
  • Does not cover Dental/Vision/Hearing
  • Does not include a prescription drug plan

Why choose a Supplement (Medigap) policy?

  • Freedom to choose any doctor in the country who accepts Original Medicare
  • Easier budgeting of medical costs
  • No Networks
  • No Referrals
  • Guaranteed Renewable as long as premiums are paid
  • If you travel frequently and need the services of a doctor/specialist in more than one location (U.S.)

What is a Medicare Advantage Plan Part C?

  • You must have Part A & Part B to be eligible for a Medicare Advantage plan (Part C)
  • Type of Medicare Health plan offered by private companies that contract with Medicare to provide all your Part A & Part B benefits
  • Most Medicare Advantage Plans also offer prescription drug coverage
  • Has an annual maximum out of pocket
  • Has a network of doctors/hospitals/pharmacies
  • Premiums starting as low as $0
  • Copays for doctor & specialist visits/labs/tests/hospital stays/surgery/ER visits/ambulance etc
  • Many have extra benefits such as dental/vision/hearing/fitness memberships/over the counter products
  • Most common types of Medicare Advantage Plans are HMO, PPO, SNP, PFFS
  • Can change annually during open enrollment unless you have end stage renal (Oct 15 – Dec 7) 
  • Some special election periods may apply

Why Choose an Advantage Plan?

  • Many plans with premiums as low as $0
  • Offers an annual maximum out of pocket
  • May offer extra benefits such as dental/vision/hearing/fitness memberships/chiropractor/over the counter products
  • Most Advantage plans include Part D (prescription drug plan)
  • Veterans can use this as a back up to their VA benefits

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