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How To Decide Between Medicare Advantage And Medigap

By: Lindsay Malzone
Tel: 800-845-2484
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Even with Original Medicare, beneficiaries still have out-of-pocket costs, including coinsurance and deductibles, which can quickly add up. That's why it’s a good idea to purchase supplemental coverage to help with health care expenses.

Medicare Advantage and Medigap give beneficiaries two options to fill in the coverage gaps. Advantage plans are available through private insurance companies and are an alternative to Original Medicare. On the other hand, Medigap coverage, also known as Medicare Supplement insurance, works with Original Medicare.

It's important to note that you cannot enroll in an Advantage plan and a Medicare Supplement plan at the same time. Therefore, you should consider different factors, including your lifestyle, health needs, and budget, when weighing both options.

Medicare Advantage Costs, Coverage, and More

Medicare Advantage is Part C of Medicare. Advantage plans typically include benefits like coverage for prescription drugs, dental, vision, and more. It’s important to understand the pros and cons of Advantage plans.

Pros of Medicare Advantage

Medicare Advantage plans come with additional benefits like dental, vision, and hearing coverage. Depending on the plan you select, you may have coverage for gym memberships and transportation to doctor appointments. Your location plays a critical role in whether you'll have a zero-dollar premium plan. You may also find Advantage plans with a Part B give back option.

Cons of Medicare Advantage

Although monthly premiums are low, Advantage plans come with higher out-of-pocket costs. Another concern among some enrollees is the restrictive networks of doctors and the fact that their plan may not travel with them outside their state, or even outside their county. Many beneficiaries become frustrated with these plans because they can’t easily predict their out-of-pocket costs.

Medigap Costs, Coverage, and More

Insurance companies selling Medigap policies must abide by federal regulations. Meaning, benefits for each lettered plan need to be the same across all states and carriers. Here's a look at Medigap's pros and cons, as well as how it compares to Medicare Advantage.

Pros of Medigap Insurance

Medigap offers more flexibility when it comes to coverage, compared to Medicare Advantage plans. Unlike Advantage plans, Medigap enrollees can more easily estimate their out-of-pocket costs.

Another distinction between the two options: most Medigap plans don’t come with copays, while Advantage plans are mostly PPOs and HMOs, which do involve copays. With Medigap, you also have the option to see any doctor who accepts Medicare. This eliminates the need to stick to networks like on Medicare Advantage.
Some Medigap plans even provide foreign travel coverage. The most popular Medigap plans benefit people who enjoy international travel and don't want surprise out-of-pocket costs.

Cons of Medigap Insurance

Although Medigap is a solid option for many beneficiaries, it may not be the best for everyone. Two of the biggest complaints about Medicare Supplement plans are the high premiums and lack of prescription drug coverage.

Other concerns include no coverage for dental, vision, and hearing care. Thus, those with Medigap will need to pay additional premiums for ancillary policies if they want this coverage. If you’re under 65 and qualify for Medicare due to disability, you may not be able to obtain Medigap in your state. If you can get a Medigap plan in your state when you’re under 65, you’ll have limited options and need to pay much more than you would if you were 65 or older.

Considering Your Options

Now that you understand the basics of Medigap and Medicare Advantage plans, we recommend weighing both options and deciding which plan best fits your needs. Next, write down your questions and concerns. Lastly, contact an insurance agent to explore which supplemental Medicare plans are available to you.

Lindsay Malzone is the Medicare Consultant for MedicareFAQ. She has worked in the Medicare industry since 2017 and is featured in many publications as well as writing Medicare focused columns for other publications.

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