ORIGINAL MEDICARE
It’s beneficial to understand Medicare Advantage vs Medicare Supplements since those are the two main plan options. You’re not alone in your research; many beneficiaries compare Medicare Advantage and Medicare Supplements to see, which will reduce their costs the most.
We understand the details of Medicare can change anytime. We update content frequently to keep you well informed.
The content on this page matches the 2020 Medicare rules and regulations.
Some questions to consider while you analyze this information:
- Do you plan to travel?
- Are you willing to change doctors?
- Do you want to have predictable costs?
- What’s most important to you when it comes to your insurance?
What is the Difference Between Medicare Advantage vs Medicare Supplements
Those new to Medicare may notice an unfair promotion of Medicare Advantage plans. Well, we prefer a non-biased approach. Depending on your lifestyle, budget, and medical coverage needs, one plan will be more suitable than the other.
Medicare Advantage
Medicare Advantage plans are offered through private insurance companies. These companies are paid by Medicare to take on your risk. They must offer the same benefits of Medicare, and can also add additional benefits. When you join a Medicare Advantage plan, you agree to pay higher out of pocket costs in the form of cost-sharing in exchange for lower monthly premiums. They also come with a very restricted network of doctors and will not travel with you. The biggest complaint we hear from our clients is they are unable to accurately predict their out of pocket costs when they used their Advantage plans.
Medicare Supplements
Medicare Supplements are also offered through private insurance companies. They will cover the same exact services as Original Medicare. They pick up the remaining cost-sharing that you would normally be responsible for if you didn’t have any form of supplemental Medicare coverage. Unlike Medicare Advantage, you’ll never have to pay any copays with Medicare Supplements. These types of supplemental Medicare plans give you the ability to predict your costs. They also have a much larger network of doctors and will travel with you. You cannot join a Medicare Supplement plan if you have a Medicare Advantage plan.
What are the Pros to Medicare Advantage vs Medigap?
Medicare Advantage
First, let’s go over the benefits of Advantage plans. Part C plans look like an all-in-one option. Most policies are $0 a month. Many Part C plan options include Part D, dental, vision, and more. At first glance, Part C seems like a dream come true.
Medicare Supplements
Now, we can take a look at the perks of Medigap. Supplement policies give you the freedom to choose any doctor in America that accepts Medicare assignment. You’ll never need a referral with a Medigap plan. Further, Medigap covers foreign travel emergencies, extra days in the hospital, and the coinsurances you’d otherwise pay. When a severe condition develops, or emergency takes place, Medigap is the safety net you want.
What are the Cons to Medicare Advantage vs Medicare Supplements?
Medicare Advantage
On the surface, Advantage plans are appealing. But, what’s great about having a narrow network of doctors? In the future, a strict doctor network could be nothing short of frustration. Further, most Advantage plans don’t cover you outside the service area. So, you could pay 100% of the bill for the care you accept out of state. While the plans include dental, vision, and hearing, the benefits are basic. Most policies don’t include comprehensive dental care. Also, you may need a referral to see a specialist with most Advantage plans. With all the rules and regulations, it raises the question, “are Medicare Advantage plans bad?”
Medicare Supplements
Now, for Medigap, the list of cons is much smaller. Medicare Supplement plans don’t include Part D or other ancillary benefits. Further, Medigap plans can have a high premium depending on the policy and location of the beneficiary.
We understand Medicare is a complex web of details; so, I’m going to tell you a few possible scenarios to display the differences of Medicare Advantage vs Medicare Supplements.
What is a Real-Life Example of How Medicare Advantage vs Medicare Supplements Work?
Let’s say Rhonda has Medicare Advantage.
In the first scenario, I’m going to use Rhonda as an example. Rhonda initially chose Part C because of the low premium costs and Part D benefits on the policy. For the most part, Rhonda has been healthy with no concern about possible copayments.
While Rhonda did her routine lab work and physicals, but, she never worried about paying a massive bill because she didn’t have a severe health condition.
Rhonda chose Part C to save money on premiums. But, Rhonda couldn’t predict a broken hip.
Sure, Part C pays a portion of the bills, but Rhonda didn’t expect to have such high bills sent to her. Seven days in the hospital and one major surgery later, she meets almost meets her Maximum Out of Pocket.
She’ll pay:
- $300 for the ambulance
- $500 each day for days 1- 6 in the hospital or $3,000 total
- 20% of the surgery cost
- $40 for every physical therapy visit
- and so much more
So, while Rhonda may save a couple of bucks a year in premium costs, is it worth it to pay this much when something does go wrong? Or is it worth it to buy Medigap?
Since I know you love reading a good scenario, let’s take a look at how Medigap would help if Rhonda chose Medigap instead. Then, you’ll be closer to understanding which option will make the most sense for you!
Now, Let’s say Rhonda has Medigap Plan G.
Since Rhonda has a Medigap Plan G, her main concern is her monthly premium and the Part B deductible. Beyond that, Rhonda doesn’t worry about the costs.
Allow me to explain. See, Medicare covers a portion of the costs, and instead of Rhonda paying the other part, her Medigap plan pays. It’s that simple.
So, if Rhonda breaks her hip and has Medigap Plan G, her costs are less. If Plan G ends up costing Rhonda $100 per month, that’s less in annual premiums than she would pay in copayments with Medicare Advantage.
Is It Better to Have Medicare Advantage or Medigap?
Now that you know how each plan works, you’re wondering which is better. Well, let’s keep looking at Rhonda’s scenario.
The thing is, Rhonda isn’t guaranteed to break her hip. So, if Rhonda goes the year without any significant issues, the Medicare Advantage plan really could’ve saved her some money.
But, if Rhonda has a major health emergency, the Medigap plan offers the most protection. So, the question is, which option is better for you?
Will you take a gamble on good health with a Medicare Advantage plan? Or, will you sleep well knowing that IF something goes wrong, you have the coverage you need?
It has never been about which is the best; it’s about the option that’s best for you. Our recommendation will always be Medigap because we know at the end of the day, having the coverage you need is better than having just a low premium.
How Do I Choose Between Medicare Advantage and Medigap
Do you want predictable costs, the freedom to choose any doctor that accepts Medicare, to avoid referrals, and have coverage while traveling? If you answered “Yes” to those questions, you want Medigap. Are you okay with unpredictable copayments, strict doctor networks, and referrals? What if it includes Part D? If you answer “Yes” to these questions, Medicare Advantage could work for you.
The best part about working with agents that don’t care which option you choose? Well, the non-biased recommendations, of course! First, our agents can answer all your Medicare questions. Then, when you work with your agent, they’ll ask you a few questions to better understand your needs.
Once they know what you’re looking for, they can make a recommendation based on your situation. For example, if you’re looking for a Medigap plan that saves you money on premiums, our agents can make a few suggestions. But, of course, if you’re looking for Medicare Advantage type coverage, we can help too.
Give us a call at the number above to learn about your best plan options today! Or, fill out an online rate form to compare rates now!
About The Author
I turned 65 today (6-29-20) and I enrolled in “original” medicare Part A and Part B. Somewhere I had read (must have been on a different site) that “most people don’t pay a premium for Part A”. Is that true? Another site (or maybe it was this one!) stated I’d be paying about 252.00 per month for Part A. This is so confusing! And, that Part B will cost me about 144.60 per month. For all of the money that has been deducted out of our paychecks over the years, I would think that both Part A and B should be free, or pretty darn close to free. Well anyway, my understanding, based on this great website, is that Medigap is better than Part C (Medicare Advantage Plan) because of the wider network and cross-state coverage. But Medigap doesn’t offer prescription drug coverage (whereas Medicare Advantage Plan does offer it, along with vision, dental, hearing). My question is about Medigap . . . is it essentially Part A (hospitals) and B (doctors) but through a private insurance carrier? If I buy a Medigap plan and a Prescription Part D plan, do I need to cancel my enrollment in the “original” medicare Part A and B?
Hi Catherine! Happy Birthday!! (one day late) This is a fantastic question. I appreciate your positive feedback too! So, Part A is free for most beneficiaries. As long as you paid into Medicare for at least 40 quarters, it will be free. There is a monthly premium for Part B, and you are correct that the standard Part B premium is $144.60 per month for 2020. (you still have to pay the Part B premium even if you’re enrolled in an Advantage plan) You’re also correct that Medigap plans give you more comprehensive coverage than Medicare Advantage. You’ll have way less out of pocket expenses with Medigap than Advantage. In addition to Advantage plans not having decent travel coverage or a large network of doctors, they charge you copays for everything. With Medicare + Medigap, there are zero copays. Medigap does not replace your Part A and Part B, it supplements it. Meaning, you don’t need to cancel Part A and B to enroll in Medigap. You are correct, these plans are offered through private carriers, they fill in the gaps that Part A and B leave up to you to pay. This includes deductibles, as well as the 20% coinsurance under Part B. Medigap plans do not include prescription drug coverage. You’ll want to enroll in a stand-alone Part D plan for that. Part D plans offer more coverage on prescriptions than MAPDs. Ideally, you’ll want to have Part A + Part B + Medigap + Part D. To break it down, Part A is free, Part B is $144.60, Part D is usually around $33. It’s tougher to give you an estimate on your Medigap plan because there are so many factors that come into play with these premiums. However, depending on the letter plan you choose to enroll in, your monthly premium could cost anywhere between $50-$300 per month. I hope this helps! If you have any more questions, please don’t hesitate to ask.
Where is there a Plan G for 100.00 per month. I have your company’s Plan N which costs me $133.83 per month with a $20.00 copay!!! Was I not sold the most cost-effective Plan???
Premiums are dependent on multiple factors. The above amount is just used as an example. Plan G may cost someone $100 in one state, and that same person will pay more in another state for the same plan. We are a broker, not a carrier. That means we do not determine the premiums of each plan, the carrier you signed up with does. We help you compare the cost of all the plans available in your area and sign you up with the carrier that offers the lowest premiums for the plan you choose to enroll in. Let me know if you have any more questions!
I am confused about enrolling in Medigag ….”When you are first eligible” .Does that mean I must enroll immediately after age 65 or in my case, I am 87 years old but have only ever been enrolled in Medicare Part A and B. May I enroll in Medigag? Must I answer medical questions? Would asthma disqualify me?
Hi Matt! You’re first eligible for Medigap once you’re Part B is in effect. Once your Part B is active, you’ll get a 6-month window to enroll in a Medigap plan without answering health questions. If you have creditable coverage, then you’ll be eligible for a SEP that allows you to enroll without answering health questions. You can enroll in a Medigap plan at any time. However, if you have no other creditable coverage, you’ll have to answer health questions during the enrollment process. Asthma may or may not disqualify you. There are many other factors to consider. Give us a call so we can help!
Are more doctors/specialists likely to accept Advantage Plans over Medigap, due to the fact they have to deal with the government? Great web site very informative!!
Hi Steve! Thank you so much for your positive feedback, we greatly appreciate it! To answer your question, it’s actually the opposite. Over 800,000+ doctors across the United States accept Medicare. With Medicare Advantage, you’ll find that many doctors are not in their network. I would imagine it’s easier to work with the government over private insurance companies regarding Medicare. Just because Medicare already has an agreement with doctors on costs for their services, so they know what they’re going to get paid for the most part. Each Advantage plan carrier can set their own prices, which can make the process of getting paid for those services more time-consuming.
Under the section for Medicare Supplements it says. “Enroll at Anytime”
You can enroll in a Medigap plan at any time. As long as you join during your open enrollment window, you won’t have to answer health questions. If you have a pre-existing condition, there are no waiting periods. If you wait to enroll outside of your open enrollment, you’ll have to answer some health questions. ……………………………. Later in the section about Medicare Advantage Plans it say Once you leave a Medigap plan and switch to a Medicare Advantage plan, you may not be able to go back to your Medigap plan. Since your one-time enrollment window has most likely passed, you’ll have to go through medical underwriting to be accepted back into a plan. I am not clear on this. I turn 65 in March 2020. If I sign up for a MAP and then 5 years later want to switch to traditional Medicare plus Medigap will I be able to do so without answering medical questions as long as it is done during open enrollment? Thanks
Hi Kathryn! Great question! There are many Open Enrollment Periods with Medicare. For Medigap plans, your Open Enrollment happens only once, unless you’re on SSDI. It starts the first day of the month your 65 and your Part B is in effect. So, if your Part B is in effect April 1st of 2020, you’ll have until the end of Septemeber to enroll in a Medigap plan without answering health questions. If you choose to enroll in a Medicare Advantage plan, the only way you can get into a Medigap plan without answering health questions is if you do this before your Open Enrollment window closes at the end of September. If you decide to keep your advantage plan for 5 years and then switch to Original Medicare + a Medigap, you will have to answer health questions. It’s important to remember that Open Enrollment and Guaranteed Issue are two different things. Just because you’re enrolling during an Open Enrollment period, doesn’t mean you have Guaranteed Issue Rights. Therefore, it’s best to enroll in a Medigap plan when your first eligible so you can do so without answering health questions.
This is the most informative site I’ve seen Re supplemental vs med. advantage. Clear & to the point! I’ll be calling to get further information.