Comparing Medicare Advantage Plans vs Medicare Supplements (Medigap)
A Medicare Supplement (Medigap) plan essentially covers the gaps in Original Medicare by paying for deductibles, copays, and coinsurance, allowing you to use any Medicare-approved provider. They are known for offering both Peace of Mind and Freedom of Choice.
Another option... a Medicare Advantage plan bundles Original Medicare with additional benefits like prescription drugs, vision, and dental care. Combines Parts A, B & D to make what's known as Part C or MAPDs. Advantage Plans usually requires you to stay within a network of providers to access the full range of coverage. Medigap plans typically have higher monthly premiums compared to Advantage plans, but offer more Provider flexibility.
Key differences:
Provider Network:
With Medigap, you can use any Medicare-approved provider or facility, while Medicare Advantage plans usually limit you to a specific network of doctors and hospitals. (HMO/PPO)
Extra Benefits:
Medigap Plans only cover what Original Medicare doesn't, while Advantage plans often include extra benefits like prescription drugs, vision, dental, hearing, OTC and wellness programs.
- NOTE: For Medigap plans, just need to add a Part D (Rx) Plan which can be as low as $0/month. Other benefits like Dental/Vision are also available with separate plans/memberships.
Premiums:
Medicare Advantage plans often have lower or Zero $ monthly premiums compared to Medigap plans. Medigap Plan N offers the lower premiums typically and they do increase each year you age typically.
Note: If your Med Supp premium has gotten too high, we can shop for a lower rate for you.
Out-of-pocket costs:
While Medigap may have higher premiums you pay each month, it can sometimes result in lower out-of-pocket costs due to the ability to use any provider with rare copays. Medicare Advantage Plans have Max Out of Pockets in the $4-10K range, though difficult to hit even with 2-3 hospital visits.
Who might choose a Medigap plan:
- People who value flexibility in choosing providers and want to avoid network restrictions.
- Access to certain specialized hospitals like MD Anderson Cancer Center in Houston
- Individuals who travel frequently and need access to a wide range of healthcare providers or have doctors in two "home towns".
- Those who prefer a simpler coverage structure with consistent out-of-pocket costs.
- Some plans offer limited coverage outside the United States.
Who might choose a Medicare Advantage plan:
- People looking for potentially lower monthly premiums and may want additional benefits like vision, dental & hearing included.
- Individuals comfortable with using a network of providers and managing their care within that network.
- Those seeking comprehensive coverage with potentially lower out-of-pocket costs if they utilize preventive services and manage chronic conditions well
- There are Special Needs Plans plans for those on Medicaid (DSNP) or have a Chronic Condition (CSNP).