Medicare helps pay for medically necessary health services. To enhance your coverage with extra benefits, consider health plans sold by private insurance companies. Let’s compare Medigap vs Medicare Advantage and see how these optional Medicare plans fit into your health care needs.
Comparing Medicare Advantage vs Medigap
Medigap and Medicare Advantage plans serve different purposes.
- Medigap, also known as Medicare Supplement Insurance, is an add-on to Original Medicare and works alongside the federal Medicare program.
- Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. You receive the same basic benefits as Original Medicare and additional benefits through a private insurance company.
Medigap Pays for Out-of-Pocket Costs
With Original Medicare coverage, you’re responsible for a portion of your health care costs. Both Part A hospital insurance and Part B medical insurance have annual deductibles that Medicare beneficiaries have to meet before Medicare pays its share. Once you’ve met the deductible, you also pay a coinsurance or co-pay each time you receive a service.
These costs can add up. Medicare Supplement Insurance pays for deductibles, coinsurance, co-pays, excess charges and other out-of-pocket costs that you incur through Original Medicare.
Medigap plans are standardized, which means insurance companies can only offer certain combinations of benefits. They can set their own premiums, however, so it’s important to comparison shop. You can choose basic Medigap policies or more extensive coverage that includes emergency care when traveling outside the country.
Medicare Advantage Plans Provide Bundled Coverage
Original Medicare covers basic medical services such as hospital stays, doctor visits, lab tests, treatments for illnesses and durable medical equipment. Prescription drugs aren’t covered unless you buy a separate Part D prescription drug plan.
To offer beneficiaries more comprehensive coverage, private insurance companies sell all-in-one Medicare Advantage plans, also known as Medicare Part C.
Medicare Advantage plans are regulated by the federal government and provide the same basic benefits as Original Medicare Parts A and B. Medicare Advantage also includes additional benefits such as dental, vision and hearing coverage. Most Part C plans provide prescription drug benefits.
These private plans let you choose how you get your health care. Some require you to use the plan’s network of hospitals and doctors, often at a lower cost. Others give you the flexibility of using out-of-network providers.
Should You Choose Medicare Advantage or Medigap Coverage?
When evaluating your health insurance needs, your first decision is whether to get Part A hospital insurance and Part B medical insurance through Original Medicare or a Medicare Advantage plan. If you choose Medicare Advantage, you can then decide on extra benefits such as vision, dental and prescription drug coverage.
If you remain on Original Medicare, you can get help paying out-of-pocket costs with Medicare Supplement Insurance. A Medigap plan is only an option if you enroll in Original Medicare — it doesn’t work with Medicare Advantage.
Speak to a licensed insurance agent to learn more about Medigap and Medicare Advantage plans. Call us at 800-309-6889 to find a health plan that best meets your needs.