Deciding between Medicare Advantage and Medigap as your supplemental insurance coverage can be confusing. While both provide additional coverage beyond Original Medicare, there are some significant differences to understand. This comprehensive guide examines how Medicare Advantage and Medigap Plan G work, compares their costs and extra benefits, and outlines key factors to help you determine the best option.
A Quick Refresher on Medicare Coverage Options
Before diving into the differences, let's review the three main Medicare coverage choices:
Original Medicare - This is the traditional Medicare program consisting of Part A (hospital coverage) and Part B (outpatient/medical coverage). It is managed directly by the federal government.
Medigap - Also called Medicare Supplement Plans, these are sold by private insurance companies and are designed to cover cost-sharing amounts in Original Medicare like deductibles and coinsurance.
Medicare Advantage - These health insurance plans are offered by private insurers and provide an alternative way to get Medicare benefits through managed care plans like HMOs and PPOs.
Both Medigap and Medicare Advantage offer ways to provide more complete coverage beyond Original Medicare, but they have some key differences.
How Medicare Supplement or Medigap Plan G Works with Original Medicare Plan
Medigap Plan G is one of ten standardized Supplement Plans (Plan A through Plan N) that help fill gaps in Original Medicare. These plans do not restrict which providers and hospitals you can use like Medicare Advantage does. Medigap Plan G covers:
How Medicare Advantage Provides Coverage
Medicare Advantage Plans are an alternate form of Medicare coverage managed by Medicare-approved private insurers. They bundle Medicare Part A, Part B, and often prescription drug coverage (Part D) together in one plan. Some key characteristics of Medicare Advantage Plans:
Both Medicare Advantage and Medigap Plan G cover all of the covered services under Original Medicare Part A and Part B. However, the way the coverage works differs:
Understanding the Provider Network Limitations
One key area of difference between Medicare Advantage and Medigap is provider access. With Medigap Plan G, you can visit any healthcare provider in the U.S. that accepts Medicare. Medicare Advantage Plans require you to see doctors and facilities within their approved network, except in emergencies.
Going out-of-network typically results in high out-of-pocket costs. Each Medicare Advantage Plan will have a different network of providers and hospitals based on who they have contracted with. Networks can change yearly.
Comparing Plan Premiums and Costs
Your budget is an important factor when selecting between Medicare Advantage and Medigap. Here is how premium costs compare:
Determining Which Plan Provides More Value
Medicare Advantage Plans often include dental, vision and hearing benefits that Medigap does not cover. These extra benefits are a primary reason some beneficiaries opt for Medicare Advantage.
However, if you wish to see any provider or hospital that accepts Medicare, Medigap's flexibility and lack of network restrictions provides value as well. There is no single "best" option for everyone. Carefully weigh the extra benefits offered by plans against total costs to make the right choice.
Conclusion on Choosing Between Medicare Advantage and Medigap
When deciding between Medicare Advantage and Medigap, consider your budget, need for extra benefits, and preference to access out-of-network providers if desired. Medigap Plan G covers Medicare deductibles, coinsurance and copays with flexibility to use any provider. Medicare Advantage Plans cost less on average but limit you to a network unless you pay more. Understanding these key differences allows you to select the plan that provides the most value for your individual healthcare needs.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at The Insurance Space a Call at (866) 717-8683. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
What is the difference between Medicare Advantage and Medicare Supplement (Medigap) Plan G?
Medicare Advantage (Part C) plans are offered by private insurers and provide all your Part A (hospital) and Part B (medical) coverage, while Medicare Supplement Plan G is a supplemental policy that works alongside Original Medicare, filling in the coverage gaps.
How do I choose between Medicare Advantage and Medicare Supplement?
The decision between the two depends on various factors including cost, coverage needs, preferred providers, and travel habits. Medicare Advantage may offer lower premiums and built-in prescription drug coverage, while Medicare Supplement Plans or Medigap policies provide more flexibility in choosing healthcare providers and fewer out-of-pocket costs.
Can I have both Medicare Advantage and Medicare Supplement?
No, it's illegal for insurance companies to sell both types of plans to the same person. As Medicare beneficiaries, you have to pick one type of coverage or the other.
Does Medicare Supplement Plan G cover prescription drugs?
No, Medicare Supplement Plans do not include prescription drug coverage, so if you have Plan G, you will need to get enrolled in Medicare Part D Plan for prescription drug coverage.
What are the differences between Medicare Advantage Plans and Medicare Part D prescription drug coverage?
Medicare Advantage Plans often include prescription drug coverage, while Medicare Part D is a standalone prescription drug plan that can be added to Original Medicare or a Medicare Supplement Plan that doesn't include drug coverage.
Can I change from a Medicare Advantage Plan to a Medicare Supplement Plan?
Yes, you have a window of time every year to change your Medicare coverage. You can switch from a Medicare Advantage Plan to a Medicare Supplement Plan during the annual enrollment period from October 15 to December 7.
Can I return to Original Medicare after being enrolled in a Medicare Advantage Plan?
Yes, you can return to Original Medicare during the Medicare Advantage Disenrollment Period from January 1 to February 14. You can also make this change during the annual enrollment period.
Will my Medicare Part B premium be covered by a Medicare Supplement Plan G?
No, Medicare Supplement insurance plans do not cover Medicare Part B premiums. You are responsible for paying your Part B premium in addition to the premium for the Medicare Supplement Plan.
What are some factors to consider when choosing a Medicare Advantage Plan?
Factors to consider include whether your preferred doctors and hospitals are in the plan's network, coverage for prescription drugs, out-of-pocket costs like deductibles and copays, and any additional benefits like vision or dental coverage.
What is the best Medicare Advantage or Medicare Supplement Plan for me?
The best plan for you will depend on your specific healthcare needs, budget, and preferred doctors. It's important to compare the different plans available in your area to find the one that aligns with your unique circumstances.