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.|
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