Differences Between Medicare Advantage vs Medigap

Knowing the differences between Medicare Advantage vs Medicare is crucial regarding your healthcare coverage benefits. If you’re signing up for Medicare, you must decide whether to enroll in Medicare Parts A and B with a supplemental insurance policy, or Medicare Part C. The names and letters can be confusing. It’s important to understand the differences between these plans before you sign up.

Differences Between Medicare Advantage vs Medigap

When Medicare was established in the 1960s, there was Medicare Part A for hospital coverage, and Part B for medical costs. Today, Parts A and B are referred to as “Original Medicare.” Original Medicare pays about 80 percent of medical costs.

To avoid paying the rest out of pocket, Medicare beneficiaries can buy supplemental insurance that covers things that Medicare doesn’t. These policies, offered by private insurance companies, are known as Medicare Supplements.

In 2003, Congress established the Medicare Advantage program. Thus, allowing private insurance companies to offer Parts A and B coverage as an alternative to Original Medicare.

This plan is also known as Medicare Part C. These plans may offer more extensive coverage than Original Medicare. However, if you have a MA plan you can’t also have a supplement plan.

Key Features of Medicare Advantage Plansmedicare advantage vs medigap

Medicare Advantage plans replace Medicare Parts A and B coverage and may also offer additional coverage.

  • Like most employer-sponsored health insurance, Medicare Advantage vs Medigap plans have provider networks, and you’ll pay more if you use out of network doctors.
  • Most plans include prescription drug coverage. If they don’t, you can sign up for a standalone Medicare Part D prescription plan.
  • You’ll still pay a Medicare Part B premium, but you may also pay an additional premium.
  • There are a variety of plans available. All offer at least the same coverage as Original Medicare. There may be a wide range of premium prices, deductibles and co-pays.
  • Plans may include vision and/or dental coverage.

Key Features of Medicare Supplement (Medigap) Plans

These plans provide insurance coverage in addition to the coverage under Parts A and B.

  • You must be enrolled in Medicare Parts A and B to get a policy.
  • There are no provider networks. You can see any health care provider that accepts Medicare.
  • It doesn’t cover prescription drugs, but you can get prescription drug coverage by enrolling in Medicare Part D.
  • There are 10 standard plans, labeled A through N, and each one offers different benefits. If you enroll in one of the most comprehensive plans, like Medicare Part F plans, your policy will cover virtually all medical costs not covered by Medicare, including the annual deductibles for Plan A and B.
  • Premiums vary by plan and by individual insurer. That means insurers may charge different amounts for the exact same coverage.
  • If you enroll during the Open Enrollment Period around your 65th birthday around your Medicare Part B effective date, you cannot be turned down or charged a higher premium because of your age or health. If you enroll later or switch coverage, it may cost more or you could be denied.
  • For vision and dental insurance, you can purchase a separate policy from a private insurer.

Figuring Out Your Options

Sorting through your Medicare options can be difficult and time consuming. At MedicareFAQ, we explain your choices and research top ranked insurance companies to find a plan that works for you, and your budget.

You can read our FAQs and/or updated healthcare news & tips on our blog.

If you’re searching for rates for any of the 4 parts of Medicare or a Medicare Supplement, please reach out to one of our senior agents so they can help you! Our service is 100% free and there’s no obligation to sign up at any point.

Give us a call on our toll free number listed above. You’ll be connected with an agent licensed in your state, or use our online feature and complete the rate form here to have an agent start comparing rates for you.

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