Medicare Advantage vs Medigap
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Medicare Advantage Q & A: Is Medicare Part C or Medigap Better for Me?
Americans who carry Medicare usually start with Original Medicare Parts A & B coverage.
However, Original Medicare has deductibles and out of pocket expenses that can be very costly if you don’t get additional coverage. Two ways to get this additional coverage is either through a MediGap Medicare Supplement policy or through a Medicare Advantage Plan.
Medicare Advantage plans and Medicare Supplements are two different things. Depending on your qualifications, location and personal needs, you might want one or both types of plans.
Contact Senior Market Agents Network at 877-209-4949 and we’ll help you get the appropriate coverage.
What is the difference between Medicare Supplement and Medicare Advantage plans?
Some people just use the terms Medicare Supplement and Medicare Advantage interchangeably. Don’t make that mistake yourself.
Yes, you buy both types of plans from private insurers. Yes, they contain valuable cost-saving techniques and coverage options for all policyholders. You can only be enrolled in either plan not both. So, it’s important to understand the difference between a Medicare Supplement and Medicare Advantage Plan before choosing a plan. How they cover you will vary.
What do Medicare Supplements Cover?
A Medicare supplement is sometimes called a Medigap policy. It comes from a private insurer. It helps supplement the costs already covered by your Original Medicare. It might help you pay for:
- Copayments
- Deductibles
- Coinsurance
- Medical care if you travel outside the U.S.
- Excess charges from Medicare Part B. For example, if a doctor does not accept full Medicare, they can charge you a percentage more for their services. Medigap might cover such costs.
When you have Medicare, your Original coverage will pay first for the services it covers. Afterwards, if there are outstanding costs, your Medigap plan will step in to cover some of them.
There are multiple types of Medigap plans out there. Some might be available in your community, and others might not. Each will work differently to cover your outstanding costs.
Some of the Medigap plans available can include:
- Plan A
- Plan B
- Plan C
- Plan D
- Plan F
- Plan G
- Plan K*
- Plan L*
- Plan M
- Plan N
Each plan will offer different benefits. Therefore, you’ll need to work alongside your insurance agent to determine which plan is right for you. Keep in mind:
- Not all insurance companies will offer all Medigap plans.
- All Medigap companies must offer at least Plan A coverage.
- Companies selling more than one Medigap plan must offer either Plan C or Plan F.
Furthermore, some plans might not be available in some states. However, Medigap plans offer consistent coverage based on their letters. For example, buying a Part A plan in Texas will get you the same coverage as a plan offered in Pennsylvania. It is always to your greatest benefit to buy a plan offered in your local area.
All MediGap (Medicare Supplement) Plans are standardized. In most states, Medigap insurance plans have the same standardized benefits for each letter category. Insurance carriers that offer a Plan A Plan C Plan F Plan G or a Plan N offer the same exact benefits that each plan provides. Rates may vary but coverage will remain the same.
Note: If you live in Massachusetts, Minnesota or Wisconsin, pay attention for differences between plans. These states structure their plans differently.
Please Note: If you enroll in either a Medigap plan or Medicare Advantage plan you will still have to pay your Part B premium on your Original Medicare.
* Plans K and L cover out-of-pocket limits. Once you spend a certain out-of-pocket amount for Medicare services, the Medigap will cover 100% of remaining costs for the rest of the year.
What do Medicare Advantage Plans Cover?
A Medicare Advantage plan is a private health plan approved by the government-run Medicare program. It is sometimes called Part C insurance. Major private insurers offer these plans.
To join an Advantage plan, you must be enrolled in Medicare Parts A & B coverage. Once enrolled in the plan, you will remain in the Medicare program. However, the Medicare Advantage plan will replace the standard Original Medicare plan.
Your Part C plan will cover nearly all services provided under Original Medicare Parts A & B, except for hospice care.
Most plans will also insure added benefits not covered by Original protection, such as:
- Prescription coverage
- Dental care
- Hearing services
- Vision exams
Advantage plans come in many shapes and sizes. They include:
- HMOs
- HMO Point-of-Service Plans (HMOPOS)
- PPOs
- Private Fee-for-Service (PFFS) Coverage
- MSAs (Medical Savings Accounts)
- Special Needs Plans (SNPs)
Most plans include a provider network. An HMO will only provide coverage for providers who are in the plans network. You will be reproable for 100% of the cost of care if you get medical services outside of the provider network. You will have to seek services within your plan’s network to receive the lowest out of pocket costs for covered care.
If you choose to enroll in a PPO, you will have coverage for medical services In and Out of Network. Bear in mind your out of pocket cost will be less for services In Network.
Contact Senior Market Agents Network at 877-209-4949 and a Licensed Agent will assist you with a Provider Lookup Tool and inform you which Medicare Advantage plans your providers accept.
What does a Medicare Advantage Plan Cost?
Medicare Advantage Plan Cost vary depending on your location and what type of plan you choose. Monthly premiums can vary from $0 - $150 per month. You will still have to pay your Original Part B premium even if you have an Medicare Advantage plan. Deductibles and other personal costs, like co-payments or coinsurance, might still apply from plan to plan.
Can you have an Medicare Advantage Plan and a Medicare Supplement?
No. The law forbids Medicare Advantage policyholders from carrying Medigap plans. However, if you plan to switch from Medicare Advantage back to Original Medicare, you will qualify to enroll in a plan.
Whether you benefit more from a Medigap plan or Medicare Advantage will often depend on what you want out of your insurance coverage.
- If you have concerns about meeting outstanding insurance costs, like your copayments, then a Medigap plan might be to your benefit.
- If you want more comprehensive coverage, in addition to your Original Part A & Part B, then an Advantage plan might help you. Given that it will cover multiple additions to original coverage, you might be able to obtain more covered care for needs critical to you.
- Most Medicare Advantage plans are only available in certain areas and operate within certain provider networks. Outside of those provider networks, they might not offer full coverage. However, Medigap plans will accompany your Original Medicare as long as you see a doctor who accepts Medicare.
The costs of these plans often vary. Medigap coverage usually is more expensive than an Advantage plan. However, with an Advantage plan, you will still face out-of-pocket costs, whereas Medigap coverage will work to reduce these costs. Therefore, each will impact your personal cost responsibility in different ways.
Contact Senior Market Agents Network at 877-209-4949 and a Licensed Agent will offer guidance on which Plan is most appropriate for your needs.
Is Original Medicare Better than Medicare Advantage?
Most people will think that Advantage plans are better than Original Medicare. Again, however, your personal preferences and needs might influence which option is more for you.
- Medicare Advantage plans provides coverage for all Original Medicare benefits and will cover benefits not offered by Original Medicare such as: Part D Prescriptions, Dental Vision Hearing and a Free Gym Club Memberships.
- Again, your location might make Original Medicare a better choice for you. For example, if you travel a lot, your Medicare Advantage plan might not offer full coverage for all hospitals or provider networks. Your Original plan will pay its full costs as long as the provider accepts Medicare, regardless of location.
- Just to Note: All plans including Medicare Advantage Plans will provide coverage where ever you travel for emergency treatments.
The best way to determine your appropriate coverage options is to talk to one of our dedicated insurance agents. We’ll help you determine the benefits and potential drawbacks to both Medigap and Medicare Advantage plans. You can Contact Senior Market Agents Network at 877-209-4949 and a Licensed Agent will assist you.
Can I Change Between a Medicare Advantage Plan and a Medicare Supplement Plan?
If you want to switch from Medicare Advantage to Medigap plans, then you will have to switch to Original Medicare as well. Likewise, to switch from Original Medicare to Medicare Advantage, you must surrender the Medigap.
Generally, you must enroll in Medigap coverage at the time of your initial enrollment period. Certain exceptions to this rule exist. However, if you wait until later to enroll, you might face penalties.
You can only switch to Medicare Advantage Plans:
- During your Initial Medicare Enrollment Period (IEP). This is a 7-month period around your 65th birthday (or another time when you qualify for Medicare).
- There is an Annual Enrollment Period (OEP) during which you can switch coverage. This period is from October 15 to December 7 each year.
- There is also an Open Enrollment Period (AEP) from January 1 to March 31 each year. During this time, you can make changes to an existing Advantage plan.
It can seem easy to confuse the October/December Annual Medicare Enrollment with the January /March Open Enrollment. However, you can only make certain changes to plans during these times.
During the AEP - October 15 - December 7
- You can switch from Original Medicare to Medicare Advantage coverage.
- You can switch from one Medicare Advantage plan to another.
- You can switch from Medicare Part D prescription Plan to another.
- If you did not buy Medicare Part D coverage when you were first eligible, then you can enroll during annual enrollment.
- You can Enroll in a Medicare Advantage Plan
During the (OEP) January 1 - March 31
- If you have a Medicare Advantage Plan, you can switch back to Original Medicare at this time and Enroll in a Medicare Supplement.
- If you switch back to Original Medicare, then you can qualify for a Part D prescription plan.
- You can make changes to your Medicare Advantage Plans during this period
- You can make changes to your Part D Prescription plans
For more information on Medigap and Medicare Advantage Coverage, contact us at 877-209-4949 or request an online quote now.