Medigap or Medicare Supplement Plans

vs Medicare Advantage plans

 

Medigap (MED SUP) or Supplemental Insurance Policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn't cover, like:
• Copayments
• Coinsurance
• Deductibles

Medigap policies are sold by private companies. Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:
• Medicare will pay its share of the Medicare-approved amount for covered health care costs.
• Then, your Medigap policy pays its share.

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Medicare Advantage (Part C) plans offer lower premiums and extra benefits (dental/vision/hearing) with restrictive networks and higher variable, out-of-pocket costs, often capping expenses annually. Medicare Supplement (Medigap) plans offer higher premiums but provide flexibility to see any doctor accepting Medicare with lower, more predictable out-of-pocket costs, but rarely include extra benefits or drugs. 

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Medicare Advantage (Part C) Pros & Cons

• Pros: Lower or $0 monthly premiums. Often bundles prescription drug coverage (Part D). Includes extra benefits like dental, vision, hearing, and fitness memberships. Limits annual out-of-pocket spending.

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Medicare Supplement (Medigap) Pros & Cons

• Pros: Use any doctor or specialist in the U.S. who accepts Medicare. No referrals needed. Predictable, low out-of-pocket costs. Plans are standardized (Plan G is the same, regardless of carrier).

• Cons: Higher monthly premiums. Does notcover vision, dental, or hearing. Does not include prescription drug coverage (must buy separate Part D). Underwriting allowed after initial enrollment, which may lead to higher costs or denial based on health. 

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Key Decision Factors

• Cost vs. Risk: Choose Advantage for lower monthly costs if you are relatively healthy. Choose Supplement if you prefer to pay more monthly for lower, fixed costs when accessing care.

• Flexibility: Choose Supplement for the freedom to choose any doctor nationwide.

• Added Benefits: Choose Advantage if you need dental, vision, or hearing coverage bundled in. 

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It is important to note that you cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time. 

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8 THINGS TO KNOW ABOUT MEDIGAP POLICIES

1. You must have Medicare Part A & Part B.

2. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

3. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.

4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

 

6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.

7. Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.