Medigap vs. Medicare Advantage

Which Supplemental Option Is Best For Your Original Medicare Plan

Medigap vs. Medicare Advantage

Which Supplemental Option Is Best For Your Original Medicare Plan

You have Original Medicare coverage, but what if you need to cover prescription drug costs or are in need of more medical insurance coverage than what is currently offered in your traditional Medicare plan? Prescription drugs have become essential in Medicare coverage, and although your traditional Medicare coverage includes hospital insurance, you find yourself needing additional Medicare benefits like prescription drugs. 

Do you have to wait for a special enrollment period? Original Medicare does not cover prescription drugs — but the good news is that Medigap plans cover out-of-pocket costs that medical services in traditional Medicare does not cover.

Seniors Wondering the Difference Between Medigap vs Medicare Advantage

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Medicare Advantage Plans

Medicare Advantage plans should cover all of the services covered by Original Medicare with optional benefits included.

Medicare Advantage plans, also known as Part C, are a type of health insurance option offered to individuals who are eligible for Medicare.  These plans are offered by private insurance companies that are contracted by the federal government to provide Medicare benefits.  Medicare Advantage plans offer the same coverage as Original Medicare, which includes hospital insurance(Part A) and medical coverage (Part B), but they may also offer additional benefits, such as prescription drug coverage, dental, vision, hearing benefits, and wellness programs.

One of the key benefits of Medicare Advantage plans is that they often have lower out-of-pocket costs than Original Medicare.  Additionally, Medicare Advantage plans typically have a cap on out-of-pocket spending, which can help individuals budget and plan for their healthcare expenses.  Medicare Advantage plans also often have provider networks, which means that individuals may need to see healthcare providers within the plan’s network to receive the full benefit of their coverage.  Overall Medicare Advantage plans can be a great option for individuals who are looking for comprehensive healthcare coverage with additional benefits, lower out-of-pocket costs, and a network of healthcare providers.  

Regardless of which Medicare Advantage plan you choose, know that you are always covered for urgent and emergency care. A majority of Medicare Advantage plans include prescription medicine coverage, and the benefits can change year to year, so it’s important to understand how a plan works before enrolling — also another reason why we’re here! We can help you prepare and review your plan annually as well to ensure you understand any changes in coverage and benefits.

MediGap Plans

Medigap is Medicare Supplement Insurance that we say helps “fill in the gaps” in Original Medicare. It’s sold by private companies and pays for close to all of the costs for covered health services and supplies. A Medigap policy can help pay for some of the remaining health care costs like copayments, coinsurance, and deductibles.

Some Medigap policies cover services that Original Medicare doesn’t cover like medical care when you travel outside of the U.S. If you have Original Medicare and you purchase a Medigap policy, Medicare will pay its share of the Medicare-Approved Amount for covered health care costs and then your Medigap insurance company pays its share.

Here are some things to know about Medigap Policies:

  • You must have Original Medicare (Part A & B).

  • You are responsible for paying the private insurance company a monthly premium for your Medigap policy, which is in addition to the monthly part B premium you pay to Medicare.

  • A Medicare Supplement Insurance policy covers only one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.

  • Any standardized Medigap policy is guaranteed renewable, regardless of health condition.

What’s the difference between Medicare Advantage and Medigap plans?

What is the difference between Medicare Advantage and Medigap? Medicare Advantage, also known as Medicare part C s a private, Medicare-approved health insurance plan designed for individuals registered in both Parts A & B (Original Medicare). It combines coverage for doctor visits, hospital care, and other medical services in one plan. Both Medicare Advantage and Medigap are supplemental options to your Original Medicare plan. Most Medicare Advantage plans to provide similar to an individual or employer HMO or PPO plan, helping lower out-of-pocket costs with predictable copayments, smaller deductibles, and out-of-pocket costs. Medicare Advantage covers out-of-pocket expenses that can save money buy You can also save money with a Medicare Advantage plan by seeing a doctor within the plan’s network.

On the other hand, a Medigap plan can work with your Original Medicare to help pay for most or all of your out-of-pocket costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. A Medigap plan can also give you more flexibility when it comes to doctor choice because you can go to anyone who accepts Medicare.

More About Medicare Advantage and Medigap

You’ll have higher monthly premiums but pay less (or nothing) when you receive care. Unlike Medicare Advantage plans, a Medigap plan does not include prescription drug coverage—you have to purchase a separate Part D plan. A Medicare Advantage plan includes prescription drug coverage. Remember, Medicare prescription drug plans have to be purchased separately when working with Medigap policies.

It’s important to remember that these two plans do not work together. If you have a Medicare Advantage policy, you cannot enroll in a Medigap plan—and vice versa. If you have any questions about whether you should choose a Medigap plan or choose Medicare Advantage, don’t hesitate to give us a call!

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