Medigap vs. Medicare Advantage: which is right for you? This is one question that many individuals and families ask when shopping for a healthcare plan to work for them. Thus, this makes selecting between Medicare Advantage and Medigap quite daunting.
Although both plans have similar features, they offer their own unique set of features and different benefits. So, if you are having issues understanding both healthcare plans to make the right choice, this blog post is just what you need. Without further ado, let’s get into it.
What is Medigap?
Medigap is also known as Medicare Supplement Insurance. It is a private insurance quote created to cover the gaps in coverage by Original Medicare (Part A and Part B). In other words, the exclusions or coverages not offered by the original Medicare are then covered by Medigap policies. In addition, these quotes are regulated and standardized by the federal government. However, keep in mind that the available plans can differ by state.
What Does Medigap Cover?
Here is what a standard Medigap policy generally covers:
- Foreign travel emergencies.
- Part A coinsurance and hospital costs.
- Part B: coinsurance and copayments.
- Wellness or preventive care services.
- The first three pints of blood.
- Part A is deductible.
- Part A hospice care coinsurance.
- Part B is deductible.
- Skilled nursing facility care coinsurance.
What Does It Not Cover?
Here are services that Medigap policies are not responsible for covering:
- Vision care.
- Long-term care.
- Health and wellness programs.
- Prescription drugs.
- Dental care.
- Non-Medicare covered services.
- Hearing aids.
- Alternative treatments.
- Private-duty nursing.
- Routine foot care.
Pros and Cons of Medigap
These are the pros and cons of having a Medigap policy:
Pros
- Unlimited access to networks.
- Cheap costs.
- Wide coverage.
- No referral is required.
- Nationwide acceptance.
- Coverage is guaranteed.
- Supplemental coverage.
- Additional benefits.
- Multiple plans are available.
- Foreign travel coverage.
Cons
- Varied premium.
- Limited plans.
- Monthly premiums.
- Potential rate rise.
- Complexity.
- Possible duplicate coverage.
- No prescription drug coverage.
- Vision and dental coverage are not supported.
- Medigap is not for everyone.
- Underwritten policies.
Who is Eligible?
To qualify for Medigap, you need to be:
- U.S. citizen or legal resident.
- Enrolled in Medicare Part A and Part B.
- Apply for Medigap within your Medigap open enrollment period.
How Much Does Medigap Cost?
The cost of a Medigap healthcare plan differs depending on the following factors:
- Insurance company.
- Type of plan.
- Age.
- Location.
- Health status.
What is Medicare Advantage?
Medicare Advantage is also known as Part C and is a form of health insurance provided by private health insurance companies that partner with Medicare. Moreover, the plans come with benefits from Medicare Part A and Part B and additional benefits like dental, wellness, and vision programs.
What Does Medicare Advantage Cover?
Here is what Medicare Advantage typically covers:
- Emergency services.
- Hospital services.
- Hearing aids.
- Preventive services.
- Doctor visits.
- Additional benefits.
- Vision care.
- Prescription drugs.
- Dental care.
What Does It Not Cover?
Even with a Medicare Advantage plan, you will not be receiving coverage for the following:
- Regular foot care
- Non-Medicare covered services.
- Long-term custodial care.
- Out-of-network services.
- Travel abroad.
- Private-duty nursing.
- Specific experimental treatments.
- Alternative treatment.
- Cosmetic surgery.
- Certain prescription drugs.
Pros and Cons of Medicare Advantage
Here are the pros and cons of Medicare Advantage:
Pros
- Predictable costs.
- Additional benefits.
- Convenience.
- No separate drug plan is required.
- All-in-one coverage.
- Multiple plans.
- Bundled services.
- Preventive services.
- Out-of-pocket maximum.
- Extra perks like wellness and transportation programs.
Cons
- Geographic limitations.
- Network restrictions.
- Possible plan changes.
- Referral is required.
- Service limitations.
- Potential for higher costs.
- Complexity.
- Coverage and benefits can differ.
Who is Eligible?
You are eligible for Medicare Advantage if you fall into any of these categories:
- Legal resident or U.S. citizen.
- Enrolled in Medicare Part A and Part B.
- Enroll during an initial, special, or annual enrollment period.
- 65 years of age or older.
How Much Does Medicare Advantage Cost?
Similar to Medigap, many factors affect the cost of getting Medicare Advantage (Part C). Meanwhile, the average cost of getting a plan is $27 per month. Some of these responsible factors include:
- Part B premium.
- Copayments and coinsurance.
- Deductibles.
- Out-of-pocket maximum.
- Location.
Medigap vs. Medicare Advantage: Which Is Right for You?
If you are having difficulties choosing between Medicare Supplement Insurance (Medigap) and Part C (Medicare Advantage), this table will help you make a good decision when shopping:
| Feature | Medigap | Medicare Advantage |
| Plan Options | Multiple plans like A, B, C, etc. | Multiple plans with different benefits |
| Coverage | Supplements Original Medicare Plan | Bundled with the Original Medicare Plan |
| Drug Coverage | Not Included | Usually Included |
| Out-of-Pocket Costs | Fixed | Varies |
| Travel Coverage | Limited | Limited |
| Additional Benefits | Limited | Usually includes dental, vision, and wellness benefits. |
| Flexibility | High | Low |
| Network Restrictions | None | Usually requires |
| Monthly Premium | Higher | Lower |
| Eligibility | You must be 65 years of age or older and have Medicare Parts A and B. | You must enroll in a plan and must have Medicare Parts A and B as well. |
How to Choose Between Medigap vs. Medicare Advantage
Your financial situation, personal preferences, and healthcare needs determine whether you need Medigap (Medicare Supplement Insurance) or Medicare Advantage (Part C). In the meantime, you might find Medicap beneficial if you want flexibility when it comes to selecting healthcare providers, comprehensive coverage without additional out-of-pocket limits, or you have high medical expenses. On the other hand, Medicare Advantage might be a better choice if you want additional benefits, lower premiums, and bundle services such as dental, vision, and drug coverage.