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Medicare Advantage vs. Medigap

Medicare Advantage (also called Medicare Part C) and Medigap (also called Medicare supplement insurance) are two types of private Medicare plans. Medigap and Medicare Advantage are very different types of insurance coverage, and you can’t have both types of plans at the same time.

We’re here to explain some of the major differences between Medicare Advantage vs. Medigap so that you can decide which type of coverage is the best Medicare plan for your needs. 

What Is Medicare Advantage?

Medicare Advantage plans replace your Original Medicare (Part A and Part B) coverage. These plans cover everything found in Part A and Part B, and many Medicare Advantage plans offer some extra benefits that are not found in Original Medicare. These extra benefits may include prescription drug coverage, dental and vision care, gym memberships and more. 

Medicare Advantage plan premiums, deductibles and copays/coinsurance may differ from Original Medicare costs, and many Medicare Advantage plans have network restrictions about where the plan may be used.

What Is Medigap?

Medigap, or Medicare supplement Insurance, is a type of plan that supplements your Original Medicare coverage by paying some of your out-of-pocket Medicare costs such as deductibles, copays, coinsurance and more. In this way, Medigap plans help fill some of the “gaps” in Original Medicare.

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What Are the Differences Between Medicare Advantage and Medigap?

The best way to describe the difference between Medicare Advantage and Medigap is that Medicare Advantage replaces your Original Medicare coverage, while Medigap supplements your Original Medicare coverage.

The table below outlines some of the key differences between a Medicare Advantage plan and a Medigap plan.

   

Medicare Advantage

Medigap

Medicare coverage Covers Part A and Part B benefits and may provide additional coverage for things like prescription drugs, dental and vision. Covers the out-of-pocket costs that are required by Part A and Part B, such as deductibles, copayments and coinsurance.
Drug coverage Many (but not all) plans include prescription drug coverage. Plans do not include drug coverage. Medigap may be used in conjunction with a Medicare Part D (prescription drug) plan.
Doctor choice Plans typically include provider networks. Members often must visit doctors within the plan network or pay more out-of-pocket for care. Plans are accepted anywhere that Original Medicare is accepted. There are no network restrictions.
Referrals Certain plans require a referral from a primary care doctor to see a specialist. Referrals are not needed.
Out-of-pocket limits Plans are required to have an annual out-of-pocket limit of no more than $8,850 in 2024. Two Medigap plans (Plan K and Plan L) have annual out-of-pocket limits. All plans serve the purpose of limiting out-of-pocket spending.
Eligibility Requires enrollment in Medicare Part A and Part B. Requires enrollment in Medicare Part A and Part B.
Plan duration Plans can end at any time, and members may need to find a new plan. Plan members are guaranteed to keep their coverage as long as they pay their plan premium.
Enrollment window During your one-time Initial Enrollment Period plus select times throughout the year. Any time of the year*, but recommended to do so during your one-time Medigap Open Enrollment Period or during another period when you have guaranteed issue rights.

What Are the Cost Differences Between Medicare Advantage and Medigap?  

The costs of a Medicare Advantage plan or a Medigap plan vary according to several factors. One primary difference is that Medicare supplement plans can offer more predictable health care spending by protecting you from potentially large Medicare bills for deductibles or copays when you receive care. 

  • With a Medicare Advantage plan, you’ll be responsible for more out-of-pocket costs when you access care. You’re typically required to meet the plan deductible, copayment or coinsurance requirements, which can be costly. 

  • With a Medigap plan, you’ll have fewer out-of-pocket costs when receiving care. That’s because these plans are designed with the specific purpose of reducing or eliminating your out-of-pocket Medicare spending.

Can You Have Medicare Advantage and Medigap at the Same Time?  

You are not allowed to have a Medicare Advantage and Medigap plan at the same time.

Learn more about Medigap by contacting one of our licensed agents † today. Our agents † can answer any additional questions you have about Medigap and help you find and compare plans available where you live.  

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