Medicare Advantage vs Medigap

Many Medicare beneficiaries don't know that Original Medicare does not cover every medical expense. There are quite a few items that are not covered including prescription drugs which usually come out of pocket. If you are enrolled in Medicare Part A and Part B but want more coverage, than private health insurance is a readily available option. Medigap and Medicare Advantage are both offered by private insurance companies and resolve the coverage gap issue. However, this is where the similarities between the two options stop.

Medicare Advantage

Medicare is made up of four major components. Part A and Part B are included in Original Medicare while Part C or Medicare Advantage and Drug Coverage or Part D makeup the rest of the plans. Medicare Advantage is an option for beneficiaries who would like to get their coverage through a private insurance company instead of Medicare. The way Part C works is that people enrolled in the program get their Hospital Insurance and Medical insurance from a private company that is under contract with the federal government. Members receive the same Part A and Part B benefits which are paid for by the government through a flat fee to private insurers.

Medicare Advantage usually goes beyond the coverage of Part A and Part B and in many cases has prescription drug insurance. These features also mean that a beneficiary ends up paying higher costs out of pocket then Original Medicare enrollees. Other major differences are related to how the services are delivered to a member. With Standard Medicare, a beneficiary can go to any doctor or care provider that accepts Medicare patients. However, with a private insurance company's Medicare Advantage Plan, an enrollee might have to go to doctors that are in the carrier's network.

Medigap

This coverage plan is called a Medical Supplement and does not replace the Part A and Part B coverage like Medicare Advantage. Instead, Medigap is provided by a private insurance provider to cover the gap left by Original Medicare. That means a beneficiary gets their Part A and Part B through the federal government and any coverage they need beyond this is taken care of by the Medigap policy. Some plans even cover the deductible and copayments associated with Original Medicare, while some plans can also offer health coverage during an emergency if the policy holder is traveling outside of the United States.

Medigap has 10 different standardized plan options that are indicated by alphabetic letters. Massachusetts, Minnesota, and Wisconsin have their own plan, which means only residents of the remaining 47 states have the ability to select from any of the 10 plans. The benefits are the same for the plans and are not affected by the private insurance provider.  However, your premium is calculated using your chosen plan, location, age and other elements.

Choosing the Right Medicare Advantage or Medigap Plan

You cannot use a Medigap plan with a Medicare Advantage plan. This means that you cannot help pay for the deductibles and co-payments and for a Part C plan through a Medigap plan. That is why beneficiaries should choose the plan that best fits their needs. If you find yourself confused by the options, get in touch with a licensed agent from e-TeleQuote on our listed Toll Free Number to get a no obligation quote.

Medicare Advantage vs Medigap