Medigap vs Medicare Advantage Plans

Posted: December 20, 2021

Medicare users may find high costs or areas in their plans where they don’t have coverage. Because of these gaps, individuals can seek out Medicare Supplement or Medicare Advantage plans to help fill in areas with little range and decrease their costs. Because you can only use one program, knowing which one works best for you is essential.

What Does Medicare Include?

It is important to identify what Medicare itself covers for those considering additional Medicare services. Medicare’s policies break down into three different parts, labeled each by a different letter:

• Part A: Hospital services coverage
• Part B: Medical services coverage
• Part D: Prescription drug coverage

Standard Medicare services include Parts A and B, and users can elect to have Part D when they initially sign up for Medicare. However, signing up late for Part D can result in fees.

While Medicare is a fairly comprehensive plan, it does not cover all users’ services. Individuals under Medicare must still pay for 20% of their medical bills, and there is no price ceiling to how much they can pay in one year, resulting in high costs for some individuals. Because of the spaces within coverage and additional expenses, many individuals seek additional coverage to round out their Medicare coverage.

What Are Medicare Supplement and Medicare Advantage Plans?

When choosing additional Medicare coverage, individuals have two choices — Medicare Supplement or Medicare Advantage. Medicare Supplement, also called Medigap, are other policies provided by private insurance companies that seek to fill the areas where standard Medicare lacks coverage for individuals. Medicare Advantage, also called Part C, is a policy offered by Medicare-approved insurance companies, like Humana, Aetna and the Kaiser Foundation, and receives government funding to provide additional coverage for individuals under Medicare.

While both policies seek to create a more comprehensive and affordable Medicare program, they each have subtle differences in the services they provide. Medigap is an additional plan that aims to help cover costs that the Original Medicare doesn’t cover, including deductibles, copays and health care costs when traveling internationally. Further, many Medigap plans include a Part D prescription drug coverage policy to help individuals pay for medications.

Part  C, however, is a plan that bundles with the Original Medicare Parts A and B to create a more comprehensive and complete coverage policy. It can cover various costs, like specific services not covered in Parts A and B, including dental treatment. Part C is often great for people with chronic illnesses and helps cover additional costs with treating conditions, like transportation costs or paying for medications available over the counter.

Benefits of Medicare Advantage Plans

For those considering Part C, you can benefit from the many options covered by this program, including:

• Cheaper alternative: Compared to Medigap, Medicare often costs less, making it an ideal coverage option for people with long-term health issues that need continuous care at a lower price. Because you can choose from several approved providers, you can find plans with lower premiums to best meet your budget.
• Network span options: When signing up for Part C, you can choose the size of your medical network. Health Maintenance Organization (HMO) has a set network of doctors and hospitals you can visit, while Preferred Provider Organization (PPO) gives you the freedom to choose where you receive treatment, but at a higher cost. Depending on your needs, you can determine your medical network’s outreach.
• Choice of coverage plan: You can choose from more than 4,800 Medicare Advantage plans from various providers, allowing you to find the right plan that fits your medical needs. Each individual has unique medical necessities, and Medicare Advantage can allow you to only pay for what you need.
• Additional benefits: Plan C includes other perks that Medigap and standard Parts A and B do not possess. With Medicare Advantage, you can receive dental care, optometrist and eyeglasses coverage and even a gym membership.

Benefits of Medicare Supplement Plans

If you are unsure why choosing Medigap insurance is right for you, you can find many benefits to using Medigap, including:

• Vast medical network: Under the Medigap plan, you have an extensive medical network, which spans the U.S. to include any doctor or hospital that accepts Medicare. This system allows individuals covered by Medigap to find the best doctors, hospitals or specialists they need to receive more individualized care that better fits their needs.
• Coverage across the U.S.: Coverage is available anywhere in the U.S., making it an excellent choice for those who frequently travel or move for work. While Medicare Advantage often limits individuals to a specific geographical area, people covered by Medigap can receive medical treatment regardless of where they currently are.
• Comprehensive plan options: Because private insurance companies provide Medigap policies and services, you can choose from several plans. Like Medicare’s parts, they have corresponding letter names, including different benefits and coverage levels. One of the most popular is Plan F, a comprehensive coverage plan with a reasonable Part B deductible. Around 66% of Medigap users opt for this plan because of its broad coverage and affordability.

Medigap vs. Medicare Advantage

When comparing Medicare Supplement versus Medicare Advantage, it can be helpful to determine the key differences between the programs. While each has its advantages, you will need to consider how those advantages fit into your medical and lifestyle needs. Critical differences between Medigap and Part C include:

• Costs: Because Part C has government funding, it costs less than Medigap, which has higher premiums. This makes Part C great for people who have chronic illnesses and frequently visit doctors, while those who travel or need access to a broader range of services and areas might save money with Medigap.
• Services: Each plan provides a different range of services. Medigap is more open with what it covers, offering a wider range and more freedom to visit specialists. Some people don’t need access to these services, so instead would benefit from what Part C offers. People with Part C might be subject to heavy fees if they require services their plan doesn’t include.
• Part D: Part D is crucial for chronic illnesses, but registration has a concise window between Oct. 15 and Dec. 7. People who miss this deadline have to pay higher premiums as a result. Medigap plans offer prescription medication coverage you can join, while those in favor of Part C will need to pay late fees or wait until registration.

When determining which plan is right for you, it is best to consider what each program offers and how much you will utilize those services. With the freedom to choose between Medigap and Part C, you will want to consider how each will best meet your individual needs.

Apply to Medigap and Medicare Advantage Plans With Health for California

Choosing between Medigap and Medicare Advantage is a big decision, and individuals must consider all their medical needs to determine which plan is best for them.

At Health for California, our quick and easy-to-use services can help you move efficiently through the health care application process. Whether using our intuitive app or talking to our free and readily available agents, we are here to answer your questions and guide you. Contact Health for California today for your free health insurance quote and discover how to receive comprehensive health care under Medicare.