Private insurers offer both Medicare advantage plan and Medigap. Medicare Advantage programs replace Original Medicare, while Medigap covers out-of-pocket costs. You can’t have Medigap and Medicare Advantage, so you must choose one.
What Is Medicare Advantage?
Plans known as Medicare Advantage (MA) are provided by commercial insurance companies. These plans are under a contract with Medicare. Medicare Advantage plans (Part C of Medicare) are private health insurance policies.
They compete with Original Medicare (Parts A, B, and D). MA will provide additional benefits as well. Such as hospital, outpatient, and often prescription medication coverage.
Anyone enrolled in an MA plan must still pay their Medicare Part B premiums in addition to the plan’s. Members of Medicare Advantage plans are required to visit doctors. However, these physicians will have to be a part of their network.
Members can get referrals to see specialists. But their out-of-pocket costs are often lower than those of conventional Medicare, and they may provide extra benefits.
Medicare Advantage Plans include HMOs, PPOs, PFFS, and Special Needs Plans (SNPs). Most insurance companies provide HMO and PPO plans, but HMOs are more prevalent.
Medicare Advantage costs include a monthly charge and copayments or coinsurance. Most Medicare users may join a zero-premium HMO or PPO that covers prescriptions.
Medicare-approved medical treatment costs are restricted to a portion of your yearly deductible. Prescription medicines, hearing aids, dental treatment, and glasses are not covered.
Even if you join a Medicare Advantage Plan, Part A’s monthly cost in 2022 is estimated to be $170.10.
You should gather urban, suburban, and rural data as Medicare Advantage plan eligibility varies by region. Health care costs are covered by both Parts A and B of Original Medicare.
After knowing how to apply for Medicare, you need to learn a few more details. For example, the federal government controls Original Medicare and Medicare Advantage Plans. Much information will be available on various resourceful sites. In 2022, Illinois is supposed to offer 166 different Medicare Advantage Plans, up from 145 the year before.
In 2022, Texans may choose from one of the 337 best Medicare advantage plans. Each Texan eligible for Medicare in 2022 can join Medicare Advantage plans in Texas that charge them nothing each month. Medicare.gov and the CMS website are wonderful for learning about Medicare’s many sections. Also, by entering your ZIP code, you may use Medicare.gov’s plan finder tool to look for and compare available best Medicare plans in your area.
What Is Medigap?
Medigap covers medical expenditures not covered by Original Medicare. If you travel and depend on Original Medicare, these plans may cover medical bills outside the U.S.
Skilled nursing, private duty nursing, hearing aids, glasses, and dental procedures are not covered. Like the best advantage plan Medicare, Medigap policies are marketed by commercial health insurance firms.
Medigap is a supplement to Original Medicare but not Medicare Advantage. John Norce, CEO of Medicare Portal, says Medigap coverage covers Original Medicare expenditures (Parts A and B).
Things to know:
- Medigap helps with Original Medicare copayments, coinsurance, and deductibles.
- Original Medicare has no out-of-pocket limit, so Medigap insurance reduces financial hardship.
- Medicare Part B covers 80% of Medicare-approved costs. Medicare supplements provide 20% of the deficit.
- Standardizing Medigap plans in 2010 let Medicare beneficiaries make educated selections. All plans starting with the same letter must have the same benefits regardless of the insurer. Another similarity across plans of the same letter is that only the price varies.
- Health insurance rates in a community are based on past and predicted care costs. Your premium will stay the same regardless of your age with these plans.
- Issue-age-rated insurance rates are the same as community-rated premiums, plus the insured’s age upon purchase. You may save money on an issue-age-rated policy by purchasing it at a lower age. If you have insurance, your premium won’t rise with age unless other factors change, such as the cost of living or medical care.
- Like issue-age-rated premiums, attained-age-rated premiums climb with the policyholder’s age. Inflation or growing prices may also cause a rise in the premium.
Insurance firms use one of three distinct rating techniques to establish rates for the plan. Community ratings, issue ratings and achieved ratings are the three types. When evaluating insurance plans, it’s crucial to understand these two terms. You may ask your insurer about the regional requirements for Medigap eligibility.
Also, in almost every state, the Medigap and Medicare Advantage programs are mutually exclusive. Medigap coverage is not allowed if you enroll in a Medicare Advantage Plan. Medigap may be an option if you go from Medicare Advantage to Original Medicare.
Medicare Advantage Plan and Medigap: Pros and Cons
Medigap and Medicare Advantage offer pros and cons depending on finances and health requirements.
We have gathered the fundamentals below to make you understand your options better. Before choosing, compare the advantages of Medigap and Medicare Advantage insurance.
Medicare Advantage Benefits
- Premiums for the best Medicare advantage plans are often less expensive than those for Medigap policies.
- Coverage for medications prescribed by a doctor is a possibility. If you choose Medigap, you must also enroll in a prescription medication plan.
- Medicare Advantage may be better than Medigap since it covers dental and eye care. It’s best to be flexible about which physicians you visit since it needs in-network care to reduce out-of-pocket expenses. Texas Medicare Advantage plans also do the same.
Concerns With Medicare Advantage Plans
- A Medicare Advantage plan limits your access to a more extensive network of doctors. The plan’s network of physicians and hospitals determines its coverage.
- Medicare Advantage plans may only cover limited locations, whereas Original Medicare does not. It’s possible that you will need to switch plans if you relocate across state lines.
- Medicare Advantage plans are commonly available, but you may not have access. If you live in a large city or another densely populated area, you may be overwhelmed by the Medicare Advantage plan options. But in more remote locations, your choices of the best Medicare plans will be more restricted.
Benefits of Medigap Coverage
- Medigap helps pay for certain Original Medicare expenditures if you wish to remain using it.
- Medigap allows you to pick your own doctors. You may visit any Medicare-accepting doctor or hospital, giving you more options.
- Medigap may be a viable alternative if your doctor isn’t in a Medicare Advantage plan’s network. Any doctor that takes Medicare will be within your reach.
- Medicare Advantage premiums are higher than Medigap premiums, but out-of-pocket costs are lower. Your yearly premium should be compared to your expected healthcare costs.
Concerns With Medigap Plans
- The primary drawback of Medigap is its high price tag. Medigap rates are generally higher than Medicare Advantage premiums. Medicare Part B monthly premiums are still required.
- If you are not Medicare-eligible by January 1, 2023, Medigap won’t pay your Part B deductible. All Medigap policy candidates must be 65 and enrolled in Original Medicare Parts A and B.
- If you don’t enroll in Medigap within six months of being Medicare-eligible, your application may be denied. You may be charged extra if you apply for Medigap coverage beyond the first enrollment period.
- Medigap insurance has been standardized in 47 states and the District of Columbia. However, even for the same plan, prices might differ from state to state. However, similarly, state-wise, Medicare advantage plan cost differs too.
Can Medicare Advantage be Swapped for Medigap?
If Medicare Advantage doesn’t meet your requirements, you may switch to Medigap. You may also change to a Medicare Advantage plan from Medigap coverage.
There are standards to follow, and switching might create problems later. Medicare enrollees may transfer the best Medicare Advantage plans from October 15 to December 7.
If you abandon Medicare Advantage, you may have trouble enrolling in Medigap. Your insurance provider must offer Medigap when you join Medicare. However, after you have signed up, there’s no promise that they will actually offer you a benefit.
If you have serious health difficulties and wish to switch from Medicare Advantage to Medigap, the insurer may charge you more. A few states guarantee you may return to Original Medicare if you have Medigap coverage.
Open Switching States All Year
- New York
- Connecticut
- Washington
States That Permit Changes During Open Enrollment
- California
- Massachusetts
- Maine
- Missouri
- Oregon
What Else Is There to Know About These Options?
The advantages of Medicare Advantage and Medigap are distinct and not necessarily similar. When choosing between the two, consider your healthcare, finances, and personal preferences.
Since Medicare Advantage plans are based on managed care models, care coordination is a standard part of them. Your Medicare Advantage plan’s network physicians and hospitals will access your medical records.
Non-medical health and wellness services are now permitted in Medicare Advantage plans as of 2019. Some programs pay for things like in-home safety items like grab bars and nutrition counseling and food delivery services.
If your plan provides such services and requests them, the plan will consider your circumstances. Due to this, Medicare Advantage plans may provide individualized treatment for their enrollees.
The main benefit of Medigap is that it covers your share of your Original Medicare expenses. Knowing this may help you budget for your healthcare costs with more confidence. It may also prevent further unpleasant surprises.
Medigap can be used at any doctor or hospital that takes Medicare, which is helpful for patients. While Medigap lets you pick your own doctors, you must coordinate your own treatment. Your doctors need to know about any and all therapies and drugs you are now undergoing.
Six Medigap policies cover medical care outside the US in case of emergency. However, there are limitations to the emergency assistance benefit for international travel.
During the first two months of a journey, it may only be used in case of an emergency. After a $250 deductible is met, the benefit covers 80% of eligible emergency expenses up to a lifetime maximum of $50,000.
Conclusion
There is no way to use Medigap coverage to pay for Medicare Advantage out-of-pocket costs. Your responsibility will be all costs, such as your deductible, co-payments, and co-insurance.
No insurer may lawfully provide Medigap if you have Medicare Advantage. So, it would be wise for you to stick with your region’s best Medicare Advantage Plan.
