Medicare Medigap
Learn more about the ABC’s and D’s of Medicare and how to make the best decision for your health and wellness needs.
We’ve heard it before–Medicare terms can be so confusing! What’s the difference between Medicare, Medigap, “Med Supp”, Medicare Advantage, Medicaid?
We’re here to help you understand these terms, and talk through the differences between Medicare Advantage and Medicare Supplement (Medigap).
Coverage Options
Making a coverage decision
When we talk about Original Medicare, we are referring to Parts A and B. Most people who qualify for Medicare (upon turning 65, or having a qualifying disability and/or health condition) would be eligible to enroll in Original Medicare.
Original Medicare covers most of your hospital and inpatient care, as well as 80% of doctor and outpatient services, but does not automatically include coverage for prescription drugs.
When you enroll in Medicare Parts A and B, you will need to make a choice:
- Enroll in a Medicare Advantage plan (Part C), which includes Part A, B, and usually Part D bundled together
- Or stick with your Original Medicare coverage, and consider optional add-ons like Medigap and Part D
While Medicare Advantage often brings more benefits beyond basic Medicare, Medigap focuses on minimizing what comes out of your pocket from those basics.
These plans offer predictability with deductibles, co-insurance, and co-payments, as well as freedom to choose any doctor that accepts Medicare. However, these plans have a separate premium from Part B, and typically do not include prescription drug coverage (Part D). If you’re someone who values the ability to see specialists across the country without referrals, and the predictability of steady payments, you may be a fit for a Medigap plan.
Now let's explore these options:
Medicare Advantage Plans |
The all-in-one alternative with extras.
These plans combine the benefits of Part A, Part B, and usually Part D, into a single plan.
They often include added coverage for dental, vision, hearing, and more—giving you a more comprehensive health care package. Plus, with Medicare Advantage, it's easier to manage your health care with one plan, one card, and one point of contact.
If you valuable health benefits not included in Original Medicare and prefer the convenience of bundled coverage under a single plan, Medicare Advantage may be a good fit for you.
Medicare Supplement Plans |
Covers costs in Original Medicare Parts A and B.
With this option, you get your coverage for Parts A and B through Original Medicare. Then you can add a Medigap (Medicare supplement) plan to cover some of the out-of-pocket member costs, like deductibles and coinsurance.
Medigap only covers items included in Original Medicare Parts A and B.
It does not include additional benefits like presciption drugs, dental, vision, etc.
Quick View | Key Differences
Medicare Advantage vs. Medigap
- Medicare Coverage: c
- Prescription Drug Coverage: Typically bundled in Medicare Advantage, not included under Medigap.
- Cost to You: Medicare Advantage plans often have lower or $0 premiums, caps on out-of-pocket costs, but may include copays, whereas Medigap has higher premiums but fewer out-of-pocket costs.
- Doctors and Hospitals: Some Medicare Advantage plans may have network restrictions; Medigap offers more flexibility to see any provider that accepts Medicare.
- Referrals: Referrals are typically necessary within Medicare Advantage HMO-style plans; usually not needed with Medigap.
- Additional Coverage and Extras: Medicare Advantage plans usually includes extras like dental, vision, hearing, and wellness benefits, rarely found in Medigap plans.
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Enrollment and Eligibility
- Enrollment Times: Medicare Advantage plans have specific enrollment periods, whereas Medigap allows for a 6-month guaranteed enrollment period when you first become eligible.
- Enrollment Eligibility: Both Medicare Advantage and Medicare Supplement require you to have Medicare Parts A and B. Medicare Advantage plans may have specific service area restrictions as well.
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We're here to help guide you.
Local benefit specialists available to help you with your questions or give you personalized assistance.