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 WebMD Connect to Care helps you find services to manage your health. When you purchase any of these services, WebMD may receive a fee. WebMD does not endorse any product, service or treatment referred to on this page. X Learn the difference between Medicare Advantage and Medigap to find the best plan for your health care needs. If Medicare won’t cover all your healthcare needs, Medicare Advantage and Medigap can help. Both Medicare Advantage and Medigap supplement original Medicare to provide more coverage, but there are some important differences between the two. 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. “Medicare Advantage plans offer the convenience of providing all of these services in one plan,” Erin Nance, MD, a New York City-based orthopedic surgeon, tells WebMD Connect to Care. “The costs and coverage details vary depending on the specific insurance company and what state you live in.” Medicare Advantage plans can be HMOs, PPOs, Special Needs Plans (SNPs), private fee-for-service (PFFS) plans, or Medical Savings Account (MSA) plans. While Medicare Advantage patients don’t need referrals to see a specialist, there are some limits when it comes to providers. “There are different types of Medicare Advantage Plans that may limit your ability to see a certain provider,” Nance says. “The vast majority of doctors accept Original Medicare and the Medigap supplemental insurance.” What is Medigap?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. For instance, under Medigap plan N, foreign emergencies and hospital visits are covered, while emergency visits cost $50. Medigap plan F, a more expensive plan, pays for Part B deductibles while covering the 20% cost of services Medicare doesn’t pay. 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. Which one is better?Both Medicare Advantage and Medigap provide advantages and disadvantages. Some advantages of Medicare Advantage include:
Some disadvantages of Medicare Advantage include:
Some advantages of Medigap plans include:
Some disadvantages of Medigap plans include:
How do you decide?“Make sure you have enough coverage to limit your financial liability in case of catastrophic injuries or disease,” Nance says. “While the plans that have better benefits often cost more, they will usually save you in the long run in terms of out-of-pocket fees.” Nance further recommends speaking to family and friends to compare experiences. Summary: Contrary to popular opinion, Medicare Advantage and Medigap are two very different types of coverage — and you can’t have both. Here’s how to know whether a Medicare Advantage plan or a Medicare Supplement plan fits your needs. If you’ve ever gone a few months (or even years) without health insurance, you’ll probably be relieved to know that once you turn 65, you can have coverage through Original Medicare for the rest of your life. While Part A (hospital insurance) and Part B (medical insurance) pay for many health care costs, they don’t cover everything. You will meet a deductible before the insurance policy kicks in — and after that, you’ll be responsible for other fees, like coinsurance (a percentage of certain costs). Also, Original Medicare doesn’t cover certain routine benefits such as vision, dental, and hearing care, so you may be paying more out of pocket than you think. To help offset those costs, some people purchase either Medicare Supplement Insurance (also called Medigap, since it helps fill in the gaps in your coverage) or a Medicare Advantage plan (also called Part C). Each type works a little differently. Here’s how to know which one might be right for you. Finding the Medicare plan that’s right for your life and budget doesn’t have to be overwhelming — eHealth is here to help. Get started now. What is Medicare Supplement Insurance?Medicare Supplement Insurance, aka Medigap, works alongside your Original Medicare. It helps cover the costs of certain services that Part A and Part B don’t pay for — things like foreign travel and excess charges (such as when a doctor doesn’t accept Medicare). It can also help cover the cost of your Part A deductible — which is $1,556 for 2022 — as well as the 20% coinsurance rates you’ll be charged for Part B coverage. Given these costs, “I would say it’s essential to have a Medigap plan to cover some of those copayments,” says Caitlin Donovan, a spokesperson for the Patient Advocacy Foundation. Even so, a 2021 report from the Kaiser Family Foundation found that about 17% of those with Original Medicare — that’s about 5.6 million people — don’t have supplemental coverage. Keep in mind that Medicare Supplement Insurance doesn’t provide stand-alone coverage, so you’ll need to be enrolled in Original Medicare first. Medigap also doesn’t cover the cost of prescription medications. For that, you’ll need a third plan — Medicare Part D. There are currently 10 different Medigap insurance plans: Plans A through D, F and G, and K through N — but Plans C and F are no longer available to people who joined Medicare after January 1, 2020. Medigap insurance plans cover 100% of your Part A coinsurance costs (the percentage you pay for services after you reach your deductible), and most will cover 100% of your Part B coinsurance and copayment costs. If you go with Medigap, remember that it will also have a monthly premium. The amount varies per plan, but it could be hundreds of dollars each month. Some plans also have deductibles and copays. What is Medicare Advantage?Medicare Advantage (MA) plans are an alternative to Original Medicare. They’re offered by private insurance companies. Under an MA plan, you’ll still get Parts A and B, but you’ll usually also have Part D, as well as other benefits such as routine hearing, vision, and dental services, all under one policy. By law, Medicare Advantage plans cover the same types of care as Original Medicare — such as hospital services, doctor appointments, and lab tests, for example. But you may have to stay within network or seek a referral before the plan will pay for the costs, says Donovan. With Original Medicare, you can see any doctor who accepts it. If you enroll in Medicare Advantage, your benefits will be administered through that private plan, which will replace your Original Medicare coverage. You also won’t be allowed to enroll in a Medicare Supplement plan or a stand-alone Part D plan. Many Medicare Advantage plans don’t charge an additional premium above the usual Part B premium. You still may have a deductible, copays, and coinsurance, but MA plans generally put a limit on how much you have to spend each year (the out-of-pocket maximum). Medicare Advantage vs. Medicare Supplement Insurance: Comparison chartHere’s an at-a-glance look at some of the differences between Medicare Advantage and Medicare Supplement Insurance. Can I buy Medigap and Medicare Advantage at the same time?No. If you have a Medicare Advantage plan, you aren’t allowed to enroll in a Medigap insurance plan unless you’re also switching your Medicare Advantage plan back to Original Medicare. If you want to enroll in Original Medicare and buy a Medigap policy, you’ll need to contact your Medicare Advantage plan and ask if you can disenroll from it. You may be able to do so only during certain times of the year, known as “enrollment periods.” Medicare Advantage vs Medicare Supplement comparison chartCan I have Medigap and Medicare Part D at the same time?Yes, you can have both policies. However, if you buy each policy from the same company, you may still be responsible for paying two separate premiums. Ready to get started? Find a plan that fits your budget and covers your doctor and prescriptions now. What is the difference between a Medicare Advantage plan and a supplement?A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.
What are the negatives of a Medicare Advantage plan?The biggest disadvantage of Medicare Advantage plans is the closed provider networks, limiting your choice of which doctor or medical facility to use. Medicare Advantage costs are also largely based on how much medical care you need, making it more difficult to budget for health care costs.
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Is medicare advantage better than medicare supplement
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