Medigap or Medicare Advantage? What’s the Difference?

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by Stacy Calloway, Medicare Expert (UnitedHealthcare Medicare Solutions)

Medigap or Medicare Advantage – Which One is Best For Me?

So you’re now 65 and it’s time to determine whether you need insurance to supplement Medicare. Which should you buy – a Medigap or Medicare Advantage plan? One thing we know – it’s important to have either one or the other to make sure you’re covered.

Aren’t they the same?

No, they are not the same, but it’s easy to understand why there is confusion. The two options do have similarities but are actually quite different – and you cannot enroll in both at the same time. Both Medigap and Medicare Advantage plans are offered by private insurances companies that are under contract with Medicare, but serve different purposes.

Which is best for me?

For most people who enroll in Medicare Parts A and B, Medigap insurance can be a good choice. That is unless you enroll in a Medicare Advantage (MA) plan. You need to weigh the advantages and disadvantages of buying traditional Medicare Parts A and B and also getting a Medigap policy vs. purchasing a Medicare Advantage plan, which combines Medicare Parts A and B, and sometimes D – and also typically covers some of what you normally pay for Medicare’s deductibles and co-payments.

Basic info about Medigap

Traditional Medicare has substantial deductibles and copayments, and out-of-pocket medical expenses can easily add up to thousands of dollars each year. The purpose of Medigap insurance is to cover these “gaps” in your Medicare plan.

Monthly expenses for Medigap plans can cost up to several hundred dollars, depending on your age, the type of plan you choose and where you live. Premiums and plan features tend to vary, so do your homework. Medigap plans come in 10 standardized policies, called Plan A all the way up to N. Each Plan A has the same features and so on, but not every state has the same plans. First you need to select the type of plan that best suits your situation, then you should compare the premium costs among different insurance companies.

There is a great deal of information you need to understand if you are to purchase the Medigap plan that makes the most sense for you. I recommend you carefully review the features of the different plans with an insurance agent. For example, some Medigap plans offer emergency coverage while traveling overseas, and others do not. Choose the plan that meets your specific situation.

Basic info about Medicare Advantage (MA)

Medicare Advantage plans offer the convenience of getting all your coverage from one source, which certainly makes life easier. In addition, MA plans may offer lower premiums than the total you might pay for Part D and Medigap plans combined. Some MA plans even provide benefits not covered by Medicare, such as dental, vision and hearing, obviously, a nice plus. However, the MA plan you choose may require you to use doctors and hospitals in your plan’s network, and going outside the network can be costly. Keep in mind that MA plans have both HMOs and PPOs; if you do not want to get referrals from your doctor, the PPO plans may be a better choice for you.

The bottom line

Medicare alone isn’t enough of an insurance policy for you at age 65 and beyond. We recommend strongly you supplement traditional Medicare with either a Medigap or Medicare Advantage policy. Determining which is the best plan for you takes time, but it is time well spent to ensure you do not get hit with potentially life-changing expenses unexpectedly.

Annual Enrollment starts October 15 – December 7. Make sure to make an appointment with your agent or attend a meeting in your area to educate yourself on the changes for the upcoming year.

Key Takeaways for Medigap Plans

Medigap plans are also known as Medicare Supplement plans because they supplement the 20% left after Medicare pays. In other words, original Medicare and a Medicare supplement plan work side-by-side
Medigap plans may also cover some costs like Medicare deductibles, coinsurance and copays.
Medigap plans are standardized plans, but the big difference with Medigap plans are the premiums. These premiums are dependent on location and the insurance company.
Keep in mind that current Medigap plans do not include prescription drug plans, so you need a separate policy for that.
The best time to enroll in a Medigap plan is during your Open Enrollment period, which is a six-month window that starts the month you turn 65 and have your Part B. During your Open Enrollment period, there is no requirement to answer any health questions or go through underwriting, so you can not be turned down. After that window closes, your acceptance is not guaranteed.

Key Takeaways for Medicare Advantage

1. With Medicare Advantage plans, you receive your Medicare benefits through a private company that contracts with Medicare. Keep in mind you are still enrolled in Medicare and must continue to pay the Medicare Part B premium.
2. As a stipulation for that contract, the private company must provide the same coverage as Original Medicare Part A and Part B and may provide additional benefits that Original Medicare does not offer, such as dental, vision, hearing and even prescription drug coverage.
3. Medicare Advantage plans often include coverage for the Part A and Part B deductibles.
4. Medicare Advantage plans include an annual out-of-pocket maximum, so you have a built-in financial safety net, which brings peace of mind.
5. The premiums for Medicare Advantage plans can be sufficiently lower than Medigap plans. When deciding on the best plan for your specific situation, talk to your doctor or a licensed insurance agent.

If you have any questions that you would like answered in this column, submit your questions to stacycalloway843@gmail.com and title your email 50plusToday, or if you would like a consultation, please visit my website at www.myagentStacyCalloway.com.

About the author

Stacy Calloway is an experienced Insurance Agent licensed in the state of Texas and currently contracted with UnitedHealthcare Medicare Solutions. Stacy educates Medicare beneficiaries on the different parts of Medicare, prescription drug plans and the benefits of becoming a Medicare Advantage or Medicare Supplement member with UnitedHealthcare. Visit Stacy’s website to learn more and follow her on Facebook!