Medicare Advantage vs Medigap: Choosing the plan that’s right for you

If you’re over 65, you’re likely reviewing your plan now during the Annual Open Enrollment Period to see if it’s the best one for you. Since all plans are not the same, it’s important to find a plan that will cover the care you need at a price you can afford — and prevent you from having significant gaps in coverage.

When it comes to filling coverage gaps, most people turn to either a Medicare Advantage or Medigap plan. However, there are a few questions to consider to ensure you are making the smartest choice for your health care. They include:

Should I sign up for Medicare Advantage or Medigap?

It all depends on your personal health care needs. Both Medicare Advantage and Medigap plans are designed to cover what Original Medicare (Part A, which provides hospital coverage, and Part B, which covers medical services) does not. Original Medicare covers 80% of your hospital costs, meaning you’ll foot the bill for the remaining 20%, which could cost thousands of dollars. Also not included in Original Medicare are prescription drugs, long-term care, or routine dental and vision care.

So what’s the difference between Medicare Advantage and Medigap?

Generally speaking, Medicare Advantage plans offer more benefits and lower monthly premiums than Medigap plans.

Medicare Advantage plans operate similarly to an individual or employer plan. Plans that include prescription drug coverage are referred to as a Medicare Advantage with Part D, or a MAPD, plan. Other plan extras may include dental, vision and hearing coverage, an over-the-counter allowance and gym membership and more. Some plans don’t charge a monthly premium and offer out-of-network coverage.

Medigap plans cover some of the costs Original Medicare leaves behind including copayments, coinsurance and deductibles. You’ll pay more for your monthly premium than you would pay for a Medicare Advantage plan, but little to nothing when you receive care.

What else do I need to know about Medigap plans?

A few highlights about Medigap plans worth noting:

• Coverage stays the same regardless of your insurance carrier.
• There are 10 standard Medigap plans, but not every insurance company offers them all.
• You can visit any medical provider who participates with Medicare.
• Prescription drug coverage isn’t included, which means you’ll have to purchase a Part D prescription drug plan separately.
• While Medicare Advantage and Medigap plans can be purchased through private insurance companies, they cannot be used together.

When should I look into a Medicare Advantage or Medigap plan?

You should review your Medicare coverage each year to make sure you’re happy with your current plan. You can make changes right now during the Medicare Annual Open Enrollment Period, running Oct. 15 to Dec. 7 each year.

There are many other tools available, like Medicare.gov, to help you understand your options and choose the perfect plan. Priority Health also provides resources, including Smart Choice – A Guide to Understanding Medicare Options or Medicare Explained learning center, which can help you understand all you need to know about Medicare.

ABOUT THE EXPERT

Tami Hibbits is vice president of Medicare/Senior Markets at Priority Health.