Medicare Advantage vs. Medicare Supplements

By Ed Crowe | General Articles | 0 comment | 25 August, 2023 | 0

Medicare Advantage vs. Medicare Supplements/Medigap

While Medicare does cover the majority of elderly Americans and provide access to some essential health services, there are many aspects of healthcare that are not covered at all by the federal program. To fill in these gaps, many eligible people end up enrolling in a Medicare Advantage policy or a Medicare Supplement policy, also known as Medigap. But which is the right choice for your unique situation? Here’s a comparison Medicare Advantage vs. Medicare Supplements/Medigap.

Medicare Advantage

Many plans have $0 deductibles, no copay for a primary care doctor’s visit, and lower copays for specialists.
Beneficiaries are restricted to a list of certain doctors, hospitals, and suppliers.
The beneficiary must also be enrolled in Original Medicare (Parts A and B).
Most policies do include at least some Part D coverage (prescriptions), as well as limited hearing, vision, and dental.
There are limited policies available that allow for out-of-network provider coverage.

Medicare Advantage is provided by private insurance carriers, and essentially replaces Original Medicare as your primary insurance provider. Some plans require more authorizations to access care under these plans. Most people will have over 30 Medicare Advantage policies to choose from, but not all plans are available in all areas.

Medicare Supplements/Medigap

These programs can be expensive, but the monthly payments are predictable.
Plans K and L have annual out-of-pocket cost limits.
Limited plans available do cover some vision, dental, and hearing services.
International travel coverage is available.
Beneficiaries will have to enroll in Part D separately, as Medigap does not provide prescription coverage.
These policies only cover one person – spouses need separate plans.

There are 10 Medigap plans to choose from that provide standardized care and help pay for things like deductibles, coinsurance, and copays. In 2018, about 34% of the people enrolled in Original Medicare had coverage provided by Medicare Supplements to help cover costs – which is over 11 million people. These plans can help make the out-of-pocket costs more predictable and easier to budget. One thing that people do report positively from Medigap plans is the lack of restriction on in or out of network healthcare. The estimated average monthly premium can range from $150 to $200 a month, depending on the state that you live in and the insurer.

Depending on your situation, both Medicare Advantage and Medicare Supplement (Medigap) policies can be helpful for coverage gaps in healthcare for beneficiaries of Original Medicare.