Medigap vs Medicare Advantage
Understanding the key differences between these two Medicare coverage options to help you make the best decision for your healthcare needs
Two Different Paths to Medicare Coverage
When you're eligible for Medicare, you have an important choice to make: should you supplement Original Medicare with a Medigap policy, or should you choose a Medicare Advantage plan instead?
Both options provide valuable coverage, but they work very differently. Let's break down the key distinctions to help you choose the right path.
Medigap (Medicare Supplement)
- Works alongside Original Medicare (Parts A & B)
- Helps pay Medicare deductibles and copays
- See any doctor who accepts Medicare nationwide
- No network restrictions
- Generally higher premiums, lower out-of-pocket costs
Medicare Advantage (Part C)
- Replaces Original Medicare
- Often includes prescription drug coverage
- Usually requires using network providers
- May include extra benefits like dental and vision
- Generally lower premiums, but copays per service
Side-by-Side Comparison
| Feature | Medigap (Medicare Supplement) | Medicare Advantage (Part C) |
|---|---|---|
| How It Works | Supplements Original Medicare Parts A & B by covering gaps in coverage like deductibles, copays, and coinsurance | An alternative to Original Medicare that bundles Parts A, B, and usually D into one plan offered by private insurance companies |
| Provider Network | Any doctor or hospital that accepts Medicare nationwide - no networks or referrals needed | Must generally use doctors and hospitals in the plan's network (HMO) or pay more for out-of-network care (PPO) |
| Monthly Premium | You pay your Part B premium PLUS a Medigap premium (typically $100-$300+) | You pay your Part B premium plus the plan premium (often $0-$50, some plans have no additional premium) |
| Out-of-Pocket Costs | Minimal to none - most copays and deductibles are covered by the Medigap policy | Copays for each service (doctor visits, specialists, hospital stays). Annual out-of-pocket maximum provides protection |
| Prescription Drug Coverage | NOT included - must purchase separate Medicare Part D plan | Usually included in the plan (some require separate Part D enrollment) |
| Extra Benefits | Only covers Medicare-approved services - no dental, vision, or hearing | Many plans include dental, vision, hearing, fitness memberships, and over-the-counter allowances |
| Enrollment Periods | Best time is during 6-month Medigap Open Enrollment (starts when you turn 65 & enroll in Part B). Guaranteed issue during this period | Annual Enrollment Period (Oct 15 - Dec 7). Can also enroll when first eligible for Medicare or during Special Enrollment Periods |
| Medical Underwriting | May require medical underwriting after initial enrollment period (varies by state) | No medical underwriting - cannot be denied for pre-existing conditions |
| Travel Coverage | Excellent for travelers - most plans cover emergency care abroad (up to plan limits) | Limited to network area (except emergencies). May need different plan if you split time between states |
| Referrals | Never required - see any specialist directly | HMO plans typically require referrals to see specialists. PPO plans usually don't |
| Annual Changes | Plan benefits are standardized and cannot change (except for premium adjustments) | Plans can change networks, costs, and benefits annually |
| Best For | Those who want predictable costs, maximum flexibility, travel frequently, see multiple specialists, or have complex health needs | Those who want lower premiums, extra benefits, don't mind network restrictions, and are generally healthy |
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