which is right for me medigap or medicare advantage

Which is right for me – Medicare Supplement

or Medicare Advantage? Whether a Medigap or Medicare Advantage plan is best can vary by individual and by the policy involved, but in general Medigap plans have higher monthly premiums and more extensive care than a Medicare Advantage plan.

Full Answer

Should you consider Medicare Advantage or Medigap?

If you think you need additional Medicare coverage, Medicare Advantage (MA) and Medigap are two unique options to consider. Medicare Advantage is an alternative to Medicare, bundling Medicare’s parts together. Medigap works as a wraparound to original Medicare, covering out-of-pocket costs for Parts A and B.

Can you have Medicare and Medigap at the same time?

Medigap and Medicare Advantage together It is not possible for a person to have both Medicare Advantage and Medigap. The two plans do not work together. An individual may use Medigap to help pay original Medicare’s copayment, deductible, and coinsurance costs, but they may not use it to pay Medicare Advantage’s out-of-pocket expenses.

What is the difference between different Medigap plans?

The federal government and states regulate Medigap plans’ mostly standardized benefits that allow for apples-to-apples comparisons, with premium prices being the only difference between plans by the same letter name. But a few Medigap plans have added unconventional benefits over the years.

How does Medigap work with Medicare?

Medigap policies will cover you whenever you see any doctor or facility that takes Medicare. If the doctor or facility does not accept Medicare patients, Medigap won't cover any of those costs, even though it is a private insurance policy.

Is a Medigap plan better than an Advantage plan?

If you are in good health with few medical expenses, Medicare Advantage can be a suitable and money-saving choice. But if you have serious medical conditions with expensive treatment and care costs, Medigap is generally better.

What is the downside to Medigap plans?

Some disadvantages of Medigap plans include: Higher monthly premiums. Having to navigate the different types of plans. No prescription coverage (which you can purchase through Plan D)

What is the biggest disadvantage of Medicare Advantage?

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

Can I switch from Medicare Advantage to Medicare Supplement?

Once you've left your Medicare Advantage plan and enrolled in Original Medicare, you are generally eligible to apply for a Medicare Supplement insurance plan. Note, however, that in most cases, when you switch from Medicare Advantage to Original Medicare, you lose your “guaranteed-issue” rights for Medigap.

What are the pros and cons of Medigap?

Medigap Pros and ConsMedigap ProsMedigap ConsAll plans offer an additional 365 days in hospitalNot all plans cover hospital deductibleSome plans offer extras like excess charges, foreign travel, and Silver Sneakers programDoes not include drug coverageNationwide coverageDoesn't cover acupuncture3 more rows•Jun 4, 2015

Why should I choose a Medigap plan?

Medigap policies are sold by private companies, and can help pay for some of the costs that Original Medicare doesn't, like copayments, coinsurance, and deductibles. Some Medigap policies also cover certain benefits Original Medicare doesn't cover, like emergency foreign travel expenses.

How Much Is Medigap per month?

In 2020, the average premium for Medicare supplemental insurance, or Medigap, was approximately $150 per month or $1,800 per year, according to Senior Market Sales, a full-service insurance organization.

What are the top 3 Medicare Advantage plans?

Best Medicare Advantage Providers RatingsProviderForbes Health RatingsCMS ratingHumana5.03.6Blue Cross Blue Shield5.03.8Cigna4.53.8United Healthcare4.03.81 more row•Feb 25, 2022

What's the big deal about Medicare Advantage plans?

Medicare Advantage Plans must offer emergency coverage outside of the plan's service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs. Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D).

Why do doctors not like Medicare Advantage plans?

If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.

Who pays for Medigap?

You pay the private insurance company a monthly premium for your Medigap plan in addition to the monthly Part B premium you pay to Medicare. A Medigap plan only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

What is the difference between a Medicare Advantage plan and a Medicare Supplement plan?

Medicare Advantage and Medicare Supplement are different types of Medicare coverage. You cannot have both at the same time. Medicare Advantage bundles Part A and B often with Part D and other types of coverage. Medicare Supplement is additional coverage you can buy if you have Original Medicare Part A and B.

What is Medicare Advantage?

Medicare Advantage Health Plans are similar to private health insurance. Most services, such as office visits, lab work, surgery, and many others, are covered after a small co-pay. Plans might offer an HMO or PPO network and all plans place a yearly limit on total out-of-pocket expenses. Each plan has different benefits and rules. Most provide prescription drug coverage. Some require a referral to see a specialist while others do not. Some may pay a portion of out-of-network care, while others will cover only doctors and facilities that are in the HMO or PPO network. There are also other types of Medicare Advantage plans.

What is a Medigap policy?

Medigap policies are private plans, available from insurance companies or through brokers, but not on medicare.gov . They are labeled Plans A, B, C, D, F, G, K, L, M, and N, each with a different standardized coverage set. Plans F and G also offer high-deductible versions in some states. 12 Some plans include emergency medical benefits during foreign travel. Since coverage is standard, there are no ratings of Medigap policies. Consumers can confidently compare insurer’s prices for each letter plan and simply choose the better deal.

How many Medicare Advantage plans will be available in 2021?

Additionally, as there were more than 4,800 Medicare Advantage plans offered for 2021, it's important to take the time to find the best plan for your unique circumstances. 7

How long can you stay on medicare?

You generally won't have to pay a penalty if you later decide to enroll in a Medicare prescription drug plan and you haven't gone for longer than 63 continuous days without creditable coverage. 98.

What happens if you don't enroll in Medicare?

Once you’ve enrolled in Medicare, a key decision point is choosing coverage for Part D prescription drug insurance . If you don’t enroll in Part D insurance when you start Medicare and want to buy drug coverage later on, you may be permanently penalized for signing up late. 8

How to get started with Medicare?

To get started, find the plans available in your zip code. Once you have created an account at Medicare.gov, you can enter the names of your drugs and use a convenient tool that allows you to compare plan premiums, deductibles, and Medicare star ratings. 10 

How much does a heart bypass cost?

Let's say, for example, that you need heart bypass surgery. The cost would average $151,271, and you would be responsible for a copay —or much more if there are complications or something else goes wrong. 2

What is Medicare Advantage?

Medicare Advantage plans provide the same benefits of Original Medicare (Part A hospital insurance and Part B medical insurance) combined into one single plan. Many Medicare Advantage plans may also offer additional coverage for things like dental, vision, hearing, prescription drugs and more. To put it simply, Medigap plans are used in addition ...

Which is more expensive, Medicare or Medigap?

Medicare Advantage plans tend to be less expensive on average than Medigap plans.

What is a Medigap plan?

To put it simply, Medigap plans are used in addition to Original Medicare and provides coverage for health care expenses. Medicare Advantage plans are used as an alternative to Original Medicare and provides coverage for health care services.

How many Medicare beneficiaries were on Medigap in 2016?

In 2016, over 13 million Medicare beneficiaries also had a Medigap plan.³

What is Medicare Supplement Insurance?

Medicare Supplement Insurance plans can help provide coverage for some of the out-of-pocket costs that are tied to Original Medicare. These costs can include Medicare deductibles, coinsurance, copayments, excess charges and more.

Does Medicare Advantage cover dental?

Some Medicare Advantage plans offer $0 monthly premiums, though $0 premium plans are not available in all locations. Medigap plans do not cover prescription drugs or dental services, some of which might be covered by a Medicare Advantage plan. Deciding which type of Medicare plan is right for you will depend on how you plan to use your Medicare ...

Is Medicare Advantage a network?

Medicare Advantage plans may be a little more restrictive in where they can be used. There are several different types of Medicare Advantage plans, and some plans may include a network of participating providers. You may not always receive coverage for services obtained outside of your plan network, and any covered services you receive out of network may come with higher out-of-pocket costs.

What is the difference between Medicare Advantage and Medigap?

The main difference between the two is how they work alongside original Medicare. Medigap plans work alongside original Medicare’s Part A and Part B to help with out-of-pocket expenses, such as deductibles, coinsurance, and copayments.

How does Medicare Advantage work?

Medicare Advantage plans work in different ways, so it is advisable for people to compare all the available plans in their area. They can do this using Medicare’s find-a-plan tool. After deciding on a specific plan, a person can enroll by doing one of the following: enrolling through the company’s website.

How long does it take to switch from Medicare Advantage to Medigap?

Switching between plan types. There are three opportunities for a person to switch from Medicare Advantage to Medigap. During the initial enrollment period (IEP): This 7-month period begins the month before a person reaches 65 years of age.

What is a Medigap plan?

Medigap plans are standardized, which means that they all provide the same basic benefits. However, some plans may offer additional benefits. Once a person decides on a plan, Medicare will provide contact information for the company administering the plan.

How long do you have to switch back to Medicare after enrolling?

Shortly after enrolling: When a person first becomes eligible for Medicare and enrolls in a Medicare Advantage plan, they have 3 months in which they can switch back to original Medicare and enroll with Medigap.

When does Medicare Advantage OEP end?

During the Medicare Advantage OEP: This OEP runs from January 1 to March 31 each year. Between these dates, a person can drop their Medicare Advantage plan, return to original Medicare, or enroll in a Medigap plan.

When is the best time to buy a Medigap plan?

The best time to buy a Medigap plan is during the 6-month open enrollment period (OEP). This window automatically begins the month a person reaches the age of 65 years.

What is Medicare Advantage?

Medicare Advantage plans combine Medicare Part A (hospital insurance), Part B (medical insurance), and, usually, Part D (prescription drug coverage) in one plan, often for no more than the Part B premium. Many MA plans provide benefits like vision, hearing, and dental care that enrollees don’t get through traditional Medicare.

How many studies have found that Medicare Advantage plans perform about equally to original Medicare?

A 2021 Health Affairs review of 48 different studies found that Medicare Advantage plans perform about equally to original Medicare when it comes to:

What is a Medigap plan?

Medigap is a supplement to Medicare that helps you cover healthcare copayments, coinsurance, and deductibles from Medicare Part A and Part B. Unlike MA plans, new Medigap policies don’t provide prescription drug coverage.

How long can you keep Medigap?

You can keep your Medigap plan as long as you keep up with Medigap and Part B premiums. There are 10 standard Medigap plans named by letters A through N, but not every state offers all of them.

How many people are enrolled in Medicare Advantage in 2020?

Enrollment has more than doubled in the last decade, rising from 11.1 million in 2010 to 24.1 million in 2020. As of 2020, 39 % of Medicare beneficiaries were enrolled in an MA plan.

When is open enrollment for Medigap?

Medicare open enrollment runs every year from October 15 through December 7.

How many types of Medicare Advantage Plans are there?

There are six kinds of MA plans. The most common types of Medicare Advantage plans are:

Which is right for me – Medicare Supplement or Medicare Advantage?

Whether a Medigap or Medicare Advantage plan is best can vary by individual and by the policy involved, but in general Medigap plans have higher monthly premiums and more extensive care than a Medicare Advantage plan.

What is included and covered on Medigap plans?

Medigap plans are an extension of Original Medicare, so having Medicare Parts A and B is a requirement of their use.

What is included and covered on Medicare Advantage?

Medicare Advantage plans are private plans that are required to cover everything that would be covered by Original Medicare Parts A and B at minimum. Medicare Parts A and B cover care such as skilled nursing facilities, hospital stays, lab work, doctor visits, ambulance services, testing, etc.

When is the best time to purchase Medigap?

The best time to purchase Medigap for most people is during the 6-month open enrollment period that begins at age 65 after one enrolls in Medicare Part B. For people who don’t enroll in Medicare Part B until after they are 65, there may still be an open enrollment window, but it often comes with a late enrollment fee.

When is the best time to purchase Medicare Advantage?

Medicare Advantage first becomes available as part of the open enrollment period that lasts 6 months after one turns 65 and enrolls in Medicare Part B.

What is Medicare Advantage?

Medicare Advantage is private health insurance through Medicare that often also includes prescription drug coverage, or Medicare Part D. The plans usually provide coverage for things like vision, dental, disability services, home health, and other health care needs not covered by original Medicare.

Do Medicare Advantage patients need referrals?

While Medicare Advantage patients don’t need referrals to see a specialist, there are some limits when it comes to providers.

Does Medigap cover long term care?

Medigap, also known as Medicare Supplement Insurance, adds to original Medicare by filling in gaps where you aren’t covered. Medigap plans usually don’t cover vision, hearing, long-term care or at-home care. However, they're useful for specific types of coverage, such as health insurance while traveling or frequent emergency care.

Can you combine Medicare Advantage and Medigap?

Medigap plans do not provide prescription drug coverage, and Medigap cannot be combined with Medicare Advantage. But Medigap plans are a way to tweak your Medicare to your specific situation while covering larger expenses.

What is Medicare Advantage?

Medicare Advantage, which is also referred to as Medicare Part C, is an alternative to Original Medicare. MA plans are offered by private companies that are approved by Medicare, and they provide coverage for services covered by Original Medicare Parts A and B. Some MA plans also cover extra services like dental, hearing, vision and prescription drugs.

What is a Medigap policy?

Medigap is supplemental health insurance that is purchased from private health insurance companies licensed to sell Medigap policies. These plans aren't connected with or endorsed by the federal Medicare program. With the exception of emergency medical benefits during foreign travel, they don't cover additional healthcare services and instead fill the gaps in Medicare Part A coverage. Some costs that a Medigap policy might cover include deductibles, co-pays and coinsurance.Medigap plans are labeled as Plans A, B, C, D, E, F, G, K, L, M and N, each with a different standardized set of benefits. As of January 2020, new Medigap plans don't cover the Part B deductible. Additionally, policies sold after January 2006 aren't allowed to cover prescription drugs.

What is the factor to consider when evaluating health insurance?

When evaluating how much a health insurance plan costs, the monthly premium is just one factor to consider. Other factors include whether the plan covers extra benefits and what cost-sharing expenses, such as co-pays and deductibles, are required.

Is MA insurance private?

Because MA plans are sold by private companies, there are several types of plans, each with their own unique coverage options and rules for how policyholders receive services, such as whether they need a referral to see a specialist or whether they have to receive healthcare from in-network providers.

Does Medicare have out of pocket limits?

Unlike Original Medicare, Medicare Advantage plans have maximum annual out-of-pocket limits, which can save policyholders with chronic health conditions a lot of money. On the other hand, those with Medicare Advantage plans are often more limited in where they can receive care. Another thing to consider is whether expensive drugs or equipment, such as supplies for managing diabetes, are covered by the Medicare prescription drug plan or if there's a Medicare Advantage plan that provides the necessary coverage.