Medicare Advantage vs. Medigap: What’s the Difference

One you got enrolled in Medicare, you will probably face another situation that will require you to make a major decision. You will encounter two different plans that will help you maximize your health care benefits. These plans are Medigap and Medicare Advantage plans. Before you decide which one to choose, it is best to weigh first the benefits of Medicare Advantage vs. Medigap and find out which one of them will be able to provide you the best coverage that is according to your needs.

The Differences Between Medicare Advantage vs. Medigap

Now let’s take a look get to know what is Medicare Advantage and what is Medigap so you will be able to identify their differences and know which one of the plans has the most benefits that you need.

Medicare Advantage vs. Medigap

What is Medicare Advantage

Medicare Advantage is what we also call Medicare Part C. Medicare-approved insurance companies provide it. These plans provides all the benefits of Parts A and B, except hospice care (remains covered by Medicare Part A). Additional benefits of these plans may include vision, dental, and prescription drug coverage. Generally, those with end-stage renal disease do not qualify for this plan.

When you enroll in Medicare Advantage plan, you will still have to continue paying your Part B premium.

What is Medigap?

Medigap, also known as Medicare Supplement Plans or Medicare Supplemental Insurance plans, are insurance provided by private companies. It provides coverage to it provides coverage to health care costs not covered by Original Medicare like deductibles, copayments, and premiums. Medigap has ten standardized plans offered in 47 states while Wisconsin Massachusetts and Minnesota each have their own plan offerings. Plans are labeled by letters – A, B, C, D, F, G, K, L, M, and N—and plans of the same letter offer the same benefits no matter which insurance company you get it. On the other hands, plans are offered by insurance companies at different prices. Therefore you may have different out-of-pocket costs; even the plans have standardized benefits.

Medigap don’t cover prescription drugs. You have to get a Medicare Prescription Drug Plan if you want a medication coverage.

Medigap do not cover other services that Original Medicare does not also cover vision care, dental care, and long-term care.

Which One Is Right For You?

The right plan for you the one that will suit your needs.You have to compare the plans and To find the perfect plan for you, compare the plan’s benefits in relation to your needs.

The key factors that you need to consider in comparing benefit and costs of plans are:

  • Monthly premiums – see if it fits your budget
  • Deductibles
  • Estimated or expected healthcare costs and medical / hospital services that you always use
  • Doctors, hospital and pharmacy preferences
  • The cost of prescription drugs that you regularly need.
  • Maximum out-of-pocket amount

What If You Like Both

Unfortunately, even though you have the means to afford the two plans, you can’t have both. Medigap don’t work with Medicare Advantage Plans and vice versa. That means you can’t buy and use Medigap to pay for copayments, premiums, or deductible from your Part C Medicare Advantage plan.

What If I Changed My Mind?

If you have a Medigap Plan and decide to enroll in Medicare Advantage plan, it is best to drop your Medigap plan since it doesn’t work to pay what Advantage Plan didn’t cover.  But if you again changed your mind, you can drop your Advantage Plan and enroll again in Medigap. You can do this and still have guaranteed issue rights when you are still in the trial period. The trial period lasts for only 12 months after you enroll in a Medicare Advantage plan for the first time.

Final thoughts

Weighing Medicare vs Medigap depends much on your health care needs and ability to sustain additional premiums. No matter what you decide to choose, it should be based strongly on your personal decision. Should you need further readings, head on to Medicare.gov.

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