Original Medicare does cover many health care expenses, but not everything. Just having Original Medicare (Part A and B), you could have major costs when you have a medical claim. Also, there are deductibles and coinsurance with Original Medicare. Due to this, most people enroll in either a MA Plan or a Medicare Supplement (also known as Medigap plans) to cover those gaps in Original Medicare. Learn how to pick the right Medicare plan.
What’s the Difference Between Medicare Advantage and Medicare Supplement Insurance Plans?
Everyone’s health needs are different, as are these two options when it comes to Medicare choices.
How does Medicare Advantage work?
MA Plans are an alternative to Original Medicare. Even though you still have Medicare while enrolled in a MA Plan, you’ll get your Medicare benefits through your MA Plan. You will get additional benefits with MA Plans, such as dental, routine vision, prescription drugs, and hearing (exams and aids).
With a MA Plan, it is good to stay in network to get the best cost, and you may need a referral to see a specialist.
How does Medigap work?
With a Medicare Supplement plan (Medigap) you are still enrolled in Part A and B, and Medicare primarily pays for your health care bills. Your claims go to Medicare first, then to your Medicare supplement carrier. Since Original Medicare does not cover prescription drugs, neither will your Medicare Supplement. You’ll need to also get a stand-alone Prescription Drug Plan (PDP) when choosing a Medicare Supplement plan.
If you have a Medicare Supplement plan, you can go to any provider or facility in the U.S. that accepts Medicare. You do not need referrals with a Medicare Supplement plan.
Compare Medicare Advantage and Medigap
Looking at what benefits you need and the costs can help you choose the best plan for your health needs.
| Medicare Advantage | Medigap | |
| Are Part A and Part B coverage provided by Original Medicare? | No. MA Plans replace Original Parts A and B | Yes |
| Is there a monthly premium? | These plans are usually a $0 premium, but not all. | Yes |
| Is there a Part B deductible? | No | Yes, unless you have a Plan F or C. |
| Is there a Part B premium? | Yes | Yes |
| Are prescription drugs covered? | In most MA Plans, but not all. | No |
| Are routine dental, hearing, and vision services covered? | In most MA Plans, but not all. | No |
| What extra benefits are included? | Dental, vision, hearing, and over-the-counter products. | Certain carriers include gym memberships and discounts on dental or vision services. |
| Do you have to use in-network providers? | Yes for an HMO plan, unless it’s an emergency or urgent care need.
No for PPOs |
Any physician that accepts Medicare has to accept your Medigap policy. |
| Do you have out-of-pocket costs? | Yes, including deductibles, copays, and coinsurance. | Yes, unless you were eligible for Medicare before Jan. 1, 2020. |
| Can you make changes to your plan? | Each year during Medicare Annual Enrollment Period and Open Enrollment unless other circumstances are applicable. | Yes, anytime throughout the year, if you pass Medical Underwriting. |
| Does the plan renew automatically? | Yes, usually. | Yes |
| Who does this plan work best for? | Low utilizers of health care and those needing a lower monthly budget. | Those looking for more flexibility on where to get care and predictability on cost. |
How Do You Choose the Right Medicare Plan?
The best way to choose the right Medicare plan is to take into consideration your priorities, like provider choice, travel, budget, and health conditions. Medicare Supplement gives you flexibility and choice of physicians, while MA can be more affordable monthly.
How Do You Enroll in Medicare Advantage Plans or Supplement Plans?
The hard part of this process is deciding which plan is best for you. Once that is done, enrolling is the easy part.
How do you enroll in Medicare Advantage Plans?
During a Medicare Advantage Plan enrollment period, you can enroll on the Medicare website, directly with an insurance carrier, or with the help of a licensed Medicare professional.
How do you enroll in Medicare Supplement (Medigap) Plans?
Medigap applications can be submitted at any time. Just like a Medicare Advantage Plan, you can enroll on the Medicare website, directly with an insurance carrier, or with the help of a licensed Medicare professional.
Learn More From Our Sources
- CMS.gov | Medigap (Medicare Supplement Health Insurance) | Last accessed April 2024
- Medicare.gov | Parts of Medicare | Last accessed April 2024
- Medicare.gov | Understanding Medicare Advantage and Drug Plan Enrollment Periods | Last accessed April 2024