Medicare Advantage Plans vs Medicare Supplement Plans

Fact Checked

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.

Medicare Consultant

Michele Dubbert is a licensed independent health insurance agent, working with individuals, families and small businesses. She has been in the Health Insurance industry since 2013. Her passion and specialty prevail in Medicare as she truly enjoys working with this age group.

She takes joy in learning about her clients and their needs. This assists in finding the right plan that fits their lifestyles and most importantly gives them piece of mind. Many of her clients come to her frustrated with the Medicare process, so she helps them from beginning to end.

Being a broker for many carriers allows her to offer her clients a wide range of coverage options. Her office is based in Fort Collins, CO, but serves all of Colorado. She continues to further her experience with trainings and education and is expanding to additional service states.

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