When it comes to basic medical and hospital services, Original Medicare may have you covered. But what about other services and expenses that Original Medicare doesn’t cover? Don’t worry – you have options.
Here’s what you need to know about private Medicare plans, like Medicare Advantage – plans that include all services covered by Original Medicare plus more; and Medicare Supplement plans (Medigap), which work alongside Original Medicare. Learn what they are, the differences and which plan may work for you.
Comparing Medicare Advantage and Medigap
To figure out the right fit, it’s important to know what makes these coverage options different. It really depends on your needs, and each type of plan can have pros and cons. To get started, focus on what you’re really looking for, including out-of-pocket costs, prescription drug coverage, additional benefits and more.
What to expect from a Medicare Advantage Plan
Medicare Advantage plans (Part C) work in place of Original Medicare. They’re not an addition – they’re an alternative. When you buy a Medicare Advantage plan from a Medicare-approved private insurance company, you get the coverage of Original Medicare, plus whatever additional perks and benefits your insurance company offers – often things Parts A and B don’t cover.
- Predictable costs: Most Medicare Advantage plans include copays and deductibles for covered services, as well as monthly premiums as low as $0 – which are paid in addition to your Part B premium. Unlike Original Medicare, there is an annual out-of-pocket maximum, so you never have to pay above a certain amount for services covered by your plan.
- Original Medicare: In order to be eligible for a Medicare Advantage plan, you have to be enrolled in Original Medicare Parts A and B. Medicare Advantage plans replace your Original Medicare benefits and combine them into one plan, often called Part C.
- Prescription drugs: Most Medicare Advantage plans include Part D prescription drug coverage, so you won’t need to purchase a separate plan to cover your prescriptions. In fact, if you have a Medicare Advantage plan you’re not eligible to enroll in a standalone Part D plan.
- Additional benefits: Many plans offer coverage for vision, dental, hearing and more.
- Network selection: For the lowest costs, you should see doctors and health care providers who are a part of the plan’s network. Most plans will offer some kind of out-of-network coverage, too – but it might have higher cost-sharing.
What to expect from a Medigap plan
Medicare Supplement plans (Medigap) can be purchased in addition to Original Medicare. It doesn’t replace your Original Medicare coverage and doesn’t typically offer extra benefits or coverage. Instead, it works alongside Original Medicare and helps with remaining costs Original Medicare doesn’t cover, such as Part A and Part B deductibles, copays and coinsurance.
- Predictable costs: Medigap plans include fixed monthly premiums that may change from year to year.
- Original Medicare: In order to be eligible for a Supplement plan, you have to be enrolled in Part A and Part B. You keep your Original Medicare benefits along with your Medicare Supplement plan.
- Prescription drugs: Medicare Supplement plans don’t cover prescription drugs. Many beneficiaries purchase a separate Part D plan and are responsible for those costs.
- Additional benefits: Unlike Medicare Advantage plans, Medigap plans generally do not offer additional coverage benefits, such as dental, vision and hearing.
- Network selection: There is no network. Beneficiaries can use any provider that accepts Medicare.
Can you have a Supplement plan and Medicare Advantage at the same time?
No, you cannot have both a Medicare Advantage plan and Medicare Supplement insurance. Both of these options hinge on Original Medicare – a Medicare Advantage plan replaces it, and a Supplement plan complements it by helping with coverage gaps.
Can I switch from Medicare Advantage to Medicare Supplement (Medigap)?
Yes, you can switch from either plan to the other. Keep in mind that it’s easier to switch to Medicare Advantage than it is to switch to a Supplement plan.
You can make the switch from Medigap to Medicare Advantage during the Medicare Annual Enrollment Period (AEP) or if you are eligible for a Special Enrollment Period (SEP).
You can technically switch from Medicare Advantage to a Supplement at any time, but health insurance companies are not obligated to let you enroll outside of your 6-month Medigap Open Enrollment Period. If you are able to enroll outside of your open enrollment period, you might have to pay higher premiums.
Depending on your financial situation and your health care needs, the plan that works best for you may change over time – but enrolling in either a Medicare Advantage or Medicare Supplement plan can help with costs not covered by Original Medicare.