Medicare Advantage Plans and Medigap plans cannot be combined. Medigap is intended to be used as a supplement to Original Medicare. It is against the law for anyone to sell you a Medigap policy if you are enrolled in a Medicare Advantage Plan unless you are going back to Original Medicare.
Medicare Advantage Plans may have different policies, fees, and restrictions, but they must offer at least the same set of benefits as Original Medicare parts A and B. For example, Medicare Advantage Plans might require that you visit medical professionals in their network and/or obtain a prescription from your primary care physician before consulting specialists. Some Medicare Advantage plans provide additional, Medicare-exempt benefits like dental, hearing, fitness, transportation, and more. These plans are more structured like a typical health insurance plan, offering HMO, and PPO style plans.
A Medicare Supplement Plan (Medigap), provides supplementary coverage in addition to Original Medicare Parts A and B. Depending on where you reside and when you became Medicare eligible, You can select from up to ten different Medigap plans: A, B, C, D, F, G, K, L, M, and N. (Plans in Wisconsin, Massachusetts, and Minnesota have different names.)
Each lettered Medigap plan provides a unique set of benefits, but all plans with the same letter must provide the same benefits (regardless of the company through which you purchase it). Premiums vary based on the plan you select and the company you choose to purchase it from
Your remaining out-of-pocket expenses after Original Medicare has paid its portion can be covered in part or entirely by a Medigap plan. The Medigap "gap" originates from here. If Original Medicare does not provide the coverage you need, Medigap insurance may "fill in the gaps."
Example:
Now that we have a better picture of how Medigap works with Original Medicaid, let's have a look at how Medigap stacks up to MA. Medicare Advantage and Original Medicare are compared in the table below. Keep in mind that there are several sorts of plans.
Medicare Advantage or Medigap–Which Should You Choose?
If you are in good health and have few medical bills, Medicare Advantage may be a useful and cost-effective option. However, if you have major medical issues that require expensive treatment and care, Medigap is usually preferable.
Consulting with a licensed insurance agent regarding your specific health situation can help determine which option is best for you. Since you can have both Medicare Advantage and Medigap at the same time, you must pick carefully to ensure you have adequate coverage for your individual circumstances.
The Pros of Medicare Advantage Plans
Monthly premiums for Medicare Advantage plans are often cheaper than those for Medigap policies. Prescription medicine coverage may also be included. If you choose Medigap, you must enroll in a separate medication plan.
Another significant advantage is that Medicare Advantage plans give additional coverage not accessible through standard Medicare. This can cover vision, hearing, and dental treatments, as well as gym memberships, preventative chiropractic care, and stipends for over-the-counter vitamins in some situations making the programs, especially appealing to recipients.
The Cons of Medicare Advantage Plans
One of the most significant downsides of a Medicare Advantage plan is that it restricts your ability to choose doctors, hospitals, and other health care providers. Medicare Advantage plans rely on health care provider networks; if you see a doctor or other provider who is not in your network, you will likely be required to pay a higher portion of the cost.
Because monthly premiums are sometimes low or nonexistent, many beneficiaries believe Medicare Advantage plans are less expensive options. However, the majority of the costs associated with Medicare Advantage plans are borne by copays, coinsurance, deductibles, and other out-of-pocket expenses incurred as part of the entire treatment process.
Some Medicare Advantage plans require patients to acquire prior approval or authorization before seeing a specialist, which is not always the case with Original Medicare.
The Pros of Medigap Plans
The most significant benefit of Medigap may be your choice of doctors. You have more options for physicians and hospitals since you may go to any provider who takes Medicare. While Medigap premiums are normally greater than those of Medicare Advantage, you will most likely have reduced out-of-pocket payments. You must evaluate how much you intend to pay for health care over the course of a year and compare it to your yearly premium cost.
Your insurance will automatically renew each year as long as you continue to pay your monthly payment. You don't need to change anything, but it's a good idea to review your plan and coverage every year to ensure it still matches your needs.
The Cons of Medigap Plans
Monthly premiums for Medigap policies are often greater than those for Medicare Advantage plans. You must also continue to pay your Medicare Part B monthly payments.
While you may apply for Medigap coverage at any time, you are not always guaranteed to be approved. You should join up during the Open Enrollment Period when you reach 65 for the greatest results. If you apply for coverage after the enrollment period has passed, you may be subject to medical underwriting and may be rejected coverage because to your age, medical history, or pre-existing diseases.
Plans are standardized in terms of coverage and benefits, but not in terms of cost or which plans are available in which states. Insurance companies that sell Medigap insurance are not required to provide every Medigap plan, and their prices may vary.
Can You Switch Between Medicare Advantage and Medigap?
If you sign up for Medicare Advantage and then decide it isn't for you, you can change to Medigap supplementary coverage. You can also change from Medigap to Medicare Advantage.
However, you must follow specific guidelines, and there may be complications if you wish to switch later. If you are enrolled in a Medicare Advantage plan, you can move to a different Medicare Advantage plan during the annual open enrollment period, which runs from October 15 through December 7.
You may also be unable to obtain Medigap coverage if you discontinue your Medicare Advantage plan. Insurers are obligated to offer you Medigap coverage if you are new to Medicare. However, there is no assurance that they would sell you one after the first enrolment.
When you move from a Medicare Advantage plan, insurers may charge you extra for Medigap coverage if you have major medical conditions.
Only a few states preserve your option to return to Original Medicare with Medigap coverage.
States That Allow You to Switch Year-Round
- New York
- Connecticut
- Washington
States That Allow You to Switch During Enrollment Periods
- California
- Massachusetts
- Maine
- Missouri
- Oregon
The rules governing your ability to switch differ across each of these states. You should consult your state's rules to see what applies in your situation.