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Comparison: Medicare Supplement (Medigap) Plans vs Medicare Advantage Plans

Comparison-Medicare-Supplement-Medigap-Plans-vs-Medicare-Advantage-Plans

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) PlansMedicare Advantage (Part C) Plans
Doctors and HospitalsNo 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 PhysicianUse any doctor that takes MedicareSome plans you may need to select a primary care physician.
Referral to a SpecialistNo referrals requiredHMO:  Referral is required on most plansPPO:  No referral required
Prior ApprovalNone requiredIt is important that you follow the plan’s rule, like getting prior approval for certain services.
NetworkNo 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 CoveragePrescription drugs are not included.  Consider purchasing a Part D plan.Prescription drug coverage is included with most plans. 
Gym MembershipSome 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 HearingNoMany plans do offer basic dental, vision and hearing plans. 
Out of Pocket ExpensesPredictable 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.
TravelCan 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. 
CostsYou 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?

Meet Melissa MacCalla

Medicare is not simple and can be hard, frustrating, and downright confusing for most. I love when I get someone on the phone and I am given the opportunity to explain the difference in plans to them and have Medicare make sense. I enjoy talking to clients year after year, hearing about their families growing or them asking about mine.

-Melissa

Senior Healthcare Solutions, you truly stand out from most other insurance agents. Thank you so much for all of your help and I know that you will have nothing but success with how you conduct business.

Joan B.

Montgomery, AL

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