Medigap vs. Medicare Advantage Plans

Medigap vs Medicare Advantage (Medicare Part C). They provide different types of health insurance benefits.

Medigap plans work alongside Original Medicare benefits to supplement your coverage; Medicare Advantage replaces your Original Medicare coverage, offering the same benefits plus potential additional coverage through a private health insurance plan.

You Can’t Enroll In Both Medigap and Medicare Advantage

You can’t join a Medigap plan if you’re already enrolled in Medicare Advantage. If you enroll in a Medicare Advantage plan, you can’t use a Medigap policy to cover your out-of-pocket health care expenses.

Medigap can be only be purchased by people enrolled in Original Medicare. If you have Medicare Advantage and want to join a Medigap plan, you have to switch to Original Medicare before you can buy a Medigap policy. Contact your Medicare Advantage Plan carrier to see if you can disenroll.

If you already have a Medigap policy and want to join a Medicare Advantage Plan, you must drop your Medigap policy.

Opting Out of Original Medicare With a Medicare Advantage Plan

• Medicare Advantage plans don’t supplement Medicare. Enrollees have the option of joining a Medicare Advantage plan instead of Original Medicare. The federal government requires that all MA plans cover the same benefits as traditional Medicare, except for hospice care.
• Most MA plans offer additional health benefits and services as well, but because they’re sold by private insurance companies, they have different pricing structures and network stipulations. The benefits included in a Medicare Advantage plan and the cost of the policy can vary widely based on the private insurance company providing coverage.
• Companies that sell Medicare Advantage Plans set different rules for how beneficiaries get services. Each plan has different rules regarding where you can receive care, and whether you need a referral to see a specialist. Most Medicare Advantage plans have smaller networks (doctors, facilities or suppliers that belong to the plan) than traditional Medicare.

Supplementing Original Medicare With a Medigap Policy

• Out-of-pocket health care costs left by Original Medicare coverage (Part A and Part B) are sometimes referred to as the “gaps” in Medicare.
  
  Medigap, also known as Medicare Supplement Insurance, is sold by private insurance companies to beneficiaries who want to supplement their Original Medicare benefits and fill in some of those gaps.

• Medicare can leave certain out-of-pocket costs, like coinsurance, copayment and deductibles. If you’re 65 or older and receive Medicare Part B benefits, you are eligible to supplement your benefits by purchasing a Medigap plan.

Medicare Supplement Insurance Plan Options

In most states, there are 10 standardized Medigap plans to choose from — labeled Plan A, B, C, D, F, G, K, L, M and N. 

Important: Plan F and Plan C are not available to beneficiaries who became eligible for Medicare on or after January 1, 2020.

Each plan type offers a different variation of basic health benefits coverage. Insurance companies that sell Medigap plans are required to offer the same basic benefits for same-type plans. This means that one insurer’s Plan G must offer the exact same basic benefits as another company’s Plan G option.

Policy costs and additional benefits vary based on the insurance company, but the basic benefits covered by each are the same for each type of plan regardless of where you live and what company sells the policy.

Each type of Medigap policy helps pay for some variation of the following Medicare-related health care expenses:

• Medicare Part A coinsurance and hospital costs

• Medicare Part B coinsurance or copayment

• First three pints of blood

• Part A hospice care coinsurance or copayments

• Part A deductible

• Part B deductible

• Part B excess charges

• Skilled nursing facility care coinsurance

• Foreign travel emergency care

The four benefits listed in bold above are included in each type of Medigap policy. The remaining five basic benefits may or may not be included, depending on which plan type you buy.

Use the chart below to compare the basic benefits of each type of Medigap plan.

A licensed insurance agent can help you compare Medigap plans available where you live and help you find the best plan for your coverage needs. Call to speak with a licensed agent today, or compare plans online for free with no obligation to enroll.