What’s the difference between a Medicare Supplement (Medigap) plan and a Medicare Advantage (Part C) Plan?

After you have become eligible, you have multiple options when it comes to enrolling in a Medicare Health Plan. You have many options and considerations to make when selecting the best plan for you and your healthcare needs.   

 

What are my Medicare Health Plan Options?

Original Medicare Part A and Part B and Medicare Supplement Insurance Plans

Medicare Supplement plans, also known as Medigap policies, work with Original Medicare Part A & Part B. These plans are often referred to as Medigap Plans because they help fill in the “gap” between what is covered by Original Medicare Parts A and B, and your out-of-pocket expenses. However, much like Original Medicare, Medicare Supplements do not provide Prescription drug coverage. Plans A, B, D, G, K, L, M, and N are currently available for new enrollees. Since the government regulates Medicare Supplement plans, it’s required by law to have the same base benefits for each lettered plan type. Medicare Supplement Plans (Medigap) have significant differences when it comes to cost, additional benefits, and how they work based on the plan’s provider.

Rates can be based on:

  • Attained Age – Monthly premiums based on your age at enrollment. The prices will be lower when you first enroll but may increase as you get older.
  • Issue Age – Monthly premiums based on your age at the time of application, once the policy is issued, it won’t go up.
  • Community Rated – The age of the beneficiary does not affect the premium price, monthly premiums based the same for everyone who has that Medicare Supplement insurance plan.

Medicare Part C – Medicare Advantages Plans

Medicare Advantage (Part C) plans are designed to be an alternative to Original Medicare. Medicare Advantage plans are required by the federal government to cover everything that Original Medicare Part A and Part B covers and sometimes include additional benefits like prescription drug coverage, gym memberships, dental, vision, and hearing coverage and more. The most common types of Medicare Advantage plans are available:

  • HMO – Health Maintenance Organizations generally provides in-network coverage,  requires referrals to see specialist, and prior authorization for certain services.
  • PPO – Preferred Provider Organization allows you to go out of network but at a higher cost. It also gives you the freedom to see specialists without referrals. 
  • PFFS – Private Fee-for-Service Allows you to see any provider that agrees to the plan’s terms and conditions.
  • D-SNP – Dual-Eligible Special Needs Plans are plans for beneficiaries for both Medicaid and Medicare.

Other plan types may be available but are less common. HMO Point of Service (HMO-POS) and Medicare Medical Savings Account (MSA) Plan.

When comparing Medicare Advantage plans in your service area, you will notice a difference in:

  • Premium
  • Maximum out-of-pocket
  • Deductibles 
  • Star Rating 
  • Network
  • Co-Pay
  • Additional benefits

 Because there are different plan types and networks associated with Medicare Advantage plans, it may be a good idea to speak with an insurance professional to ensure your primary care physician, prescription drugs, and hospitals are covered under the specific plan type.

 

How do I know what’s right for me?

 As you can see, there are many differences in Medicare Supplements and Medicare Advantage plan. You have multiple options to enroll in a plan that fits you. It’s important to consider your health, what services you need, and the providers you already see. You’ll also want to consider the cost associated with the plan, how it fits into your budget, and if you qualify for any assistance. If you would like help determining what works best for you, contact the licensed insurance professionals at Medicare Pathways.