The Difference between Medicare Advantage Plans and Medicare Supplemental Plans (Medigap)
When choosing the correct Medicare plan for you, it is important to understand the distinct differences between Medicare Advantage Plans and Medicare Supplemental plans (Medigap). While both plans offer coverage for medical costs, they are very different, and it is important to consider your specific needs and financial situation before making a decision.
With a Medicare Advantage plan you are stepping away from the original Medicare part A and B. These plans are run by private HMO’s, PPO’s or other private fee-for-service companies approved by Medicare. While these plans must still cover all of the same services that Medicare part A and B do, they can do it at a different and often cheaper cost.
A few things to keep in mind when considering a Medicare Advantage plan are that they may require you to see a specific PPO provider for in-network coverage and they may also require a referral to see a specialist. Also, you will still have to pay your Medicare part B premiums. Most Medicare Advantage plans have no additional premium charge, but the ones that do usually have extra benefits, such as, vision and dental coverage. The plans often include prescription coverage and some even offer gym memberships.
With a Medicare Supplemental Policy or Medigap Policy you are choosing to keep your traditional Medicare part A and B coverage but purchasing a secondary coverage to fill in the gaps. The gaps being any deductibles, coinsurance or copayments that Medicare does not cover. Healthcare providers will bill Medicare primary and the Medigap policy secondary.
Medigap policies can be purchased from any insurance company that is licensed in your state. Subscribers often pay them a premium in addition to their Medicare part B premium. These policies are renewable at the same rate even if a new health problem arises, but they usually do not cover long-term care, prescription, vision or dental. Prescription, also known as Medicare part D, benefits can be purchased separately. One of the main benefits of a Medigap policy is that you still have your traditional Medicare coverage so you can choose to see any physician in any network that you choose and no referral would be required.
Also know that you can change your mind if you purchase a Medicare Advantage Plan or a Medigap policy and decide that it is not right for you, but you cannot have both plans at the same time. It is against the law for insurance companies to sell you a Medigap plan while you are still covered under a Medicare Advantage plan. Be sure to thoroughly research any coverage and insurance company before purchase.
Article From Inter Valley Health Plan