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Medicare Supplement (Medigap) vs Medicare Advantage: Which plan is best for me?

Keep in mind, the least expensive plan is not always the right choice.  You need to think about your current and future health care needs when deciding which plan you want because you might not be able to switch plans later.  Additionally, your medical needs are not the same as the people you know.  There is no right or wrong answer about the plan you choose.  Make your decision based on your medical needs, preferences and budget.  

There are two types of plans:  (1) Medicare Supplement (Medigap) Plans and (2) Medicare Advantage Plans.  Before you decide which type of plan that is best plan for you, you need to ask yourself a few questions:

  1. What is my budget?
  2. What are the maximum out-of-pocket expenses for plans?
  3. What are the copays and deductibles for plans?
  4. Would you rather pay more in monthly premiums and have lower out-of-pocket expenses or pay a lower premium and have a copay for services when they are provided to you?
  5. Do I want a plan that requires me to stay within a network of doctors? Or, do I want a plan that has no networks?
  6. Do I want a plan that requires me to get a referral from my primary care to go to a specialist?
  7. Do I want to travel?
  8. Do I take any infusion drugs? Many plans only cover 80% of infusion drug costs.
  9. Extra Benefits: Are extra benefits such as prescription drugs or dental, vision and hearing important to me?  Or, can I purchase a separate plan?
  10. Medical Conditions: You need to consider current and future medical needs.

Medicare Supplement (Medigap) Plans:  These are offered by private insurance companies and approved by Medicare.  There are 10 standardized plans. Learn more about Medicare Supplement (Medigap) 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. Learn more about Medicare Part C / Medicare Advantage plans.

The table below shows a high-level difference between Medicare Supplement (Medigap) plans and Medicare Advantage plans.

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:  a referral is required

PPO:  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

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 life time 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 pay as you go plan. 

We are here for you!  Compare plans today!  Let our licensed Medicare specialists compare pricing for you.  We can compare over 25+ top-rated insurance companies at one time. 

Call us for a quote: 1-866-MEDIGAP (633-4427)

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email:  info@seniorhealthcaresolutions.com