Medicare Advantage vs Medigap: how to choose.
Insights from David Harder, President · Published
Quick answer: Medicare Advantage replaces Original Medicare with one private plan that usually has a network, a yearly out-of-pocket limit and often drug coverage. Medigap stays with Original Medicare and helps pay your share of costs, with any doctor that accepts Medicare, but drug coverage needs a separate Part D plan.
What is Medicare Advantage?
Medicare Advantage (Part C) plans are offered by private companies approved by Medicare. They cover everything Part A and Part B cover, most include Part D drug coverage, and many add extras like dental, vision or hearing. Most use a network of doctors and hospitals, and every plan has a yearly limit on what you pay out of pocket for covered services.
What is Medigap?
Medigap, also called Medicare Supplement, works alongside Original Medicare. It helps pay costs Original Medicare leaves you with, like deductibles, copays and coinsurance. You can see any doctor or hospital in the country that accepts Medicare. Medigap does not include drug coverage, so most people pair it with a stand-alone Part D plan.
Which costs less?
Medicare Advantage often has a low or $0 monthly premium, then you pay copays as you use care, up to the plan's yearly limit. Medigap has a higher monthly premium, but your costs when you get care are usually lower and more predictable. The better fit depends on your health, your doctors and how much you want to budget up front.
Do my doctors matter?
Yes, a lot. With Medicare Advantage, check that your doctors, specialists and hospitals are in the plan's network. With Medigap, any provider that accepts Medicare works, which matters if you travel or spend part of the year out of state.
Can I switch later?
You can change Medicare Advantage plans or go back to Original Medicare during Annual Enrollment, October 15 to December 7, and during the Medicare Advantage Open Enrollment Period, January 1 to March 31. Buying a Medigap policy later is a different story: outside your Medigap open enrollment period, insurers can usually look at your health history and may charge more or say no.
When is the best time to buy Medigap?
Your Medigap open enrollment period. It lasts 6 months, starting the month you are 65 or older and enrolled in Part B. During that window you can buy any Medigap policy sold in Oklahoma without medical underwriting.
How Spirit Insurance Group helps
Our licensed, salaried, non-commissioned team in Tulsa lays out both paths side by side using your doctors, prescriptions and budget, then compares the plans we represent. We come to you.
Educational information, not a recommendation for a particular plan. Costs and coverage vary by plan; see each plan's Evidence of Coverage. We do not offer every plan available in your area. Currently we represent 7 organizations which offer 60 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
