Medigap and Medicare Advantage are two different ways to receive your Medicare coverage. What do they have in common and how are they different? Understanding this can help you make a good choice on which is better for your specific situation.

What are the differences between Medigap and Medicare Advantage?

Medigap Insurance

Medicare Supplement coverage, also known as a Medigap plan, is designed to fill the gaps in Original Medicare. These are private insurance policies that help pay for some of the healthcare costs that Original Medicare doesn't cover such as copayments, coinsurance and deductibles.

Medicare Advantage

Medicare Advantage is a Medicare approved plan from a private company that offers an alternative to Original Medicare. These bundled plans include Part A, Part B and usually offer additional benefits and most include prescription drug coverage.

What are the Pros and Cons of Medigap?

Pros

• Medigap plans provide additional coverage, which helps cover costs not paid by Original Medicare.
• It often provides more predictable out-of-pocket costs due to it's comprehensive coverage.
• You have more freedom of choice, which allows you to choose any doctor or provider that accepts Medicare without network restrictions.
• Generally, you can expect consistent coverage and stability, as Medigap policies are standardized.

Cons

• Medigap typically comes with a higher monthly premium.
• Medigap plan do not include prescription coverage, so you will need to purchase a Part D plan.
• You cannot use Medigap with Medicare Advantage plans; it's only for Original Medicare.

What are the Pros and Cons of Medicare Advantage?

Pros

• Medicare Advantage combines Part A, Part B and often Part D in one plan.
• Many plans have lower or even $0 monthly premiums.
• Some plans offer extra benefits like dental, vision, hearing and fitness memberships.
• Most plans have a maximum limit on out-of-pocket expenses.

Cons

• These plans have networks. You may need to use doctors and hospitals within the plan's network.
• If you go outside the network, you may face higher out of network costs.
• Some services may require prior authorization, which is an approval before receiving certain services.
• Medicare Advantage plans can change their benefits and costs each year.

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How do I choose between Medigap and Medicare Advantage?

When deciding whether to get a Medigap or a Medicare Advantage plan, there are a few things to consider. You can either use original Medicare with a Medigap policy or choose a private Medicare Advantage plan. If you go with Original Medicare, you can see any doctor or facility that accepts Medicare. However, you will need to buy separate policies to help with out of pocket costs.

If you choose Medicare Advantage, you may pay low or no premium, besides your monthly Part B premium. Keep in mind that out-of-pocket costs can vary if you use more medical services. Medicare Advantage plans have networks, so you may have to see doctors within their network. Depending on the plan, if you visit an out-of-network doctor, your plan might not cover the visit or you might have to pay more. Also, some services may require prior authorization before the service is covered by the plan.

Get help navigating your Medicare options

We understand comparing different Medicare plans and deciding on the right one can feel overwhelming, but it doesn't have to be. Our expert team can assist you with your plan options and help ensure your coverage meets your budget and specific needs. We can look through multiple Medicare plans from various insurance carriers and see which may be the right fit for you. Feel free to give us a call today and we will help you compare prices and benefits all in one place.

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