There are two types of plans: (1) Medicare Supplement (Medigap) Plans and (2) Medicare Advantage Plans.
Medicare Supplement (Medigap) Plans:
These are offered by private insurance companies and approved by Medicare. There are 10 standardized plans.
Medicare Advantage Plans:
These are offered by private insurance companies and approved by Medicare. You will continue to pay your Part B premium to Medicare. With these plans, you give up Original Medicare (Part A and Part B) and the insurance company you choose will manage the plan for you.
The table below shows a high-level difference between a Medicare Supplement (Medigap) plan and a Medicare Advantage plan.
Comparison: Medicare Supplement (Medigap) Plans vs Medicare Advantage Plans
| Medicare Supplement (Medigap) Plans | Medicare Advantage (Part C) Plans | |
| Doctors and Hospitals | No networks: You can choose any doctor, hospital or facility in the United States that accepts Medicare. | Networks: You will normally be required to use doctors and hospitals in your network. |
| Primary Care Physician | Use any doctor that takes Medicare | Some plans you may need to select a primary care physician. |
| Referral to a Specialist | No referrals required | HMO: Referral is required on most plansPPO: No referral required |
| Prior Approval | None required | It is important that you follow the plan’s rule, like getting prior approval for certain services. |
| Network | No network restrictions. Coverage goes with you across the United States. | You have network restrictions. Emergency care is covered when you travel within the United States. |
| Prescription Drug Coverage | Prescription drugs are not included. Consider purchasing a Part D plan. | Prescription drug coverage is included with most plans. |
| Gym Membership | Some insurance companies do offer gym memberships for free or reduced fee. Ask your agent to explain. | Many plans do include gym membership. |
| Dental, Vision and Hearing | No | Many plans do offer basic dental, vision and hearing plans. |
| Out of Pocket Expenses | Predictable out of pocket expenses. These expenses are low to $0 (not including premium). | Deductibles and copays. You pay as you go. There is a maximum out-of-pocket for each plan. |
| Travel | Can travel anywhere in the United States. International travel has a $50,000 lifetime maximum. | There are Regional plans that may cover you in some states. No International travel. Review this option carefully if you travel. |
| Costs | You pay a monthly premium based on age, gender, and zip code. Out of pocket costs are limited. | Low to $0 monthly premium. When you use the services, you will pay copays and deductibles. Again, this is more of a pay-as-you-go plan. |
Learn More: Should I stay with Original Medicare or Choose a Medicare Advantage Plan?
People Also Read: I have a Medicare Supplement (Medigap) plan, do I need a Medicare Advantage plan?
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