As Medicare open enrollment approaches, we often receive many questions about the differences between Medicare Advantage plans and Medicare Supplemental (Medigap) plans. Both plans offer excellent coverage options, but one may suit your needs better depending on your circumstances. Let's explore the key differences to help you decide which option might work best for you.
Medicare Advantage
Medicare Advantage plans are lower-cost options that typically bundle Medicare Parts A, B, and D into one comprehensive package. Here, the insurance company replaces original Medicare and often provides extra benefits such as routine dental and hearing care. Most people choose a $0 premium plan with Medicare Advantage, but you will still need to pay your Part B premium.
Key Features:
- Cost: Lower cost with many $0 premium plans.
- Coverage: Combines Medicare Parts A, B, and usually D into one plan.
- Additional Benefits: May include extra services like dental and hearing.
- Out-of-Pocket Limits: Includes a maximum limit on out-of-pocket expenses.
- Provider Networks: Requires you to use specific provider networks and may require pre-approval for some services.
Pros:
- Low cost
- Comprehensive coverage
- Out-of-pocket expense limits
Cons:
- Requires using provider networks
- Typically involves copays and deductibles
- Some services must be pre-approved
Medicare Supplemental Plans (Medigap)
Medigap plans supplement original Medicare by filling in coverage gaps left by Medicare Parts A and B. Unlike Medicare Advantage, Medigap does not replace original Medicare. Instead, it covers additional costs such as copays and deductibles. With Medigap, you pay a monthly premium for the supplemental plan and your Part B premium.
Key Features:
- Cost: Requires a monthly premium in addition to the Part B premium.
- Coverage: Supplements original Medicare, covering additional out-of-pocket costs.
- Flexibility: No provider networks; you can use any medical facility that accepts Medicare.
- Prescription Coverage: Most Medigap policies do not cover Part D; you will need a separate plan for prescription drugs.
Pros:
- No provider networks; coverage at any Medicare-accepting facility
- Covers out-of-pocket costs after Medicare pays
- No prior authorization required for services
Cons:
- Monthly premium cost
- Does not cover Part D (prescription drugs)
- Does not include extra routine services not covered by original Medicare
We understand that this information can be overwhelming. Take your time to review these points, and when you’re ready, schedule a consultation with us. We can discuss which option would be the best fit for your situation. It's crucial to make an informed decision to ensure you get the coverage that meets your healthcare needs.
Schedule a consultation with Findlow Insurance today to discuss your Medicare options and find the best plan for you.
