Private insurers offer Medicare Advantage and Medigap plans, but they differ significantly. While Medicare Advantage plans replace Original Medicare and often offer more coverage, Medigap is supplementary and helps to address gaps by covering Original Medicare out-of-pocket expenses. 

How are Medicare Advantage Plans operate?

Original Medicare is an alternative, as are Medicare Advantage programs. These private insurance plans, which include all of the Original Medicare benefits, may also provide additional benefits for services not covered by Medicare. Prescription medicine coverage, hearing, dental, and vision care are possible extra benefits.

After signing up for Medicare Part A hospital and Medicare Part B medical insurance, you can purchase a Medicare Advantage plan. Your Medicare Part A and Part B coverage are replaced when you join a Medicare Advantage plan.

How Are Medigap Plans Operated?

Coinsurance, copayments, and deductibles are just a few items that Medigap is designed to fill up where Original Medicare falls short.

For Medicare-covered treatments like your doctor’s visits and other outpatient medical services and supplies, Original Medicare only covers 80% of the cost. A Medigap plan may partially or entirely cover the 20% gap you must spend out-of-pocket.

Medigap cannot cover anything that Medicare Part A and Part B do not cover. Because Original Medicare does not cover hearing, vision, or dental treatments, you cannot use Medigap to pay for either.

How Do Medigap and Medicare Advantage Differ?

You can visit any physician or healthcare facility that accepts Medicare if you have Medigap coverage. With a Medicare Advantage plan, on the other hand, you could have fewer options when it comes to physicians and other healthcare professionals.

Legally speaking, a Medicare Advantage plan cannot include Medigap insurance. You might be able to swap between the two plans, though.

Major differences Between Medigap and Medicare Advantage

Depending on your needs, Medicare Advantage and Medigap plans might offer a variety of alternatives. To be sure you’re obtaining the greatest coverage for your financial position and healthcare requirements, you should thoroughly evaluate Medicare plans.

Medicare Advantage vs. Medigap Comparison

Choice of physicians

Medicare Advantage: You must utilize doctors who are part of the plan’s network, or you will incur higher out-of-pocket costs.

Any doctor or hospital that accepts Medicare may be used if you have Medigap.

Costs

Medicare Advantage: A monthly premium of an additional $19 (for 2022) over and above your Medicare Part B premium.

Medigap: In 2022, the typical Medigap premium will be $1,956 per year ($163 monthly).

Coverage

Medicare Advantage: This Covers Medicare Parts A and B, but the majority also offer supplementary benefits, including prescription medicines, vision, dental, and hearing care.

Original Medicare Parts A and B are still available, and you can choose from eight Medigap plans with varying levels of coverage.

In-Pocket Maximum

Medicare Advantage: Plans must limit yearly out-of-pocket expenses to a combined total of $11,300 for in-network treatments and $7,550 for services provided inside the plan’s network.

Medigap: If you’re worried about Medicare’s lack of ceilings or limits, Medigap coverage can help. Each plan offers distinct benefits and distinct out-of-pocket expenses.

Coverage for Prescription Drugs

Plans like Medicare Advantage may offer prescription medication coverage.

Medigap: Separate Medicare Part D prescription medication coverage must be purchased.

Referrals

Medicare Advantage: You might need a prescription from your primary care physician to see a specialist.

Referrals from your primary care physician are not necessary for Medigap.

Is Medigap Insurance Better Than Medicare Advantage?

Medicare Advantage may be a sensible and affordable health insurance agency if you have little medical bills and good health. However, Medigap is often preferable if you have major medical issues that require pricey care and treatment.

Discussing your health status with a medicare insurance agent may determine which is ideal for you. You must make a thoughtful decision to ensure adequate coverage for your unique circumstances since you cannot simultaneously have Medicare Advantage and Medigap.

You may choose between Medicare Advantage and Medigap with more knowledge if you weigh your priorities and consult a qualified insurance agent about your specific requirements.

Changing the type of plan

A person has three options for switching from Medicare Advantage to Medigap.

• The seven-month initial enrolment period (IEP) starts the month before a person becomes 65 years old.
• When Medicare Advantage OEP is in effect: Every year, from January 1 to March 31, this OEP is in effect. 
• A person may cancel their Medicare Advantage plan, 
• Return to traditional Medicare, or sign up for a Medigap plan between these dates.
• A few months after signing up: After initially becoming eligible for Medicare and signing up for a Medicare Advantage plan, a person has three months to switch back to the original Medicare and sign up for Medigap.