Medicare Advantage vs. Medigap (Medicare Supplement)


The Medicare Annual Enrollment Period is upon us and the conversation almost always begins with explaining the differences between Medicare Advantage plans and Medicare supplemental (Medigap) plans. They’re both great, truly, but one may be better than the other in certain circumstances.


So, let’s dig in quick on a few key differences:


Medicare Advantage

Advantage plans are lower cost options that typically wrap parts A, B and D into one package. The insurance company replaces original Medicare and may provide a few extra benefits such as routine dental and hearing. Most people choose a $0 premium plan with Advantage, but you still have to pay your part B premium.

Like traditional health insurance, you typically pay a copayment and deductible, but your plan comes with an out-of-pocket maximum limit. You also have provider networks, and some services must be pre-approved, much like traditional health insurance.

Pros:

  • Low cost

  • Wraps all parts into one plan, usually including part D

  • Out-of-pocket limits

Cons:

  • Requires provider networks

  • Typically requires copays and deductibles

  • Some additional services must be pre-approved

Medicare Supplemental Plans (Medigap)


Medigap plans supplement original Medicare, filling in the gaps Medicare Parts A and B don’t cover. Rather than replacing Parts A and B, original Medicare still provides these coverages while the Medigap plan covers your copays and deductibles. Like Advantage, you still need to pay your Part B premium, but unlike

Advantage, you also pay a monthly Medigap premium.


Unlike Advantage plans, you do not have a provider network, allowing you the flexibility to enjoy coverage at any medical facility that accepts Medicare. Most Medigap policies do not cover Part D. If you buy a Part D plan, you do so separately and you are responsible for the deductible and copays.


Pros:

  • No Provider networks, covers you anywhere that accepts Medicare

  • Pays out-of-pocket costs after original Medicare.

  • Covers all services approved by Medicare, no prior-authorizations required

Cons:

  • Monthly Premium

  • Does not cover Part D

  • Does not provide any extra routine services not covered by original Medicare

We know this is a lot to digest, so take some time to go over it and then reach out so that Nick can talk about which option would be the best fit for your situation. It’s important to get this one right.


You can reach Nick for an appointment via phone at 417-258-2541 or email at nlayman@smartinsuranceagency.com


*Content provided in partnership with Levitate.


"We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information all your options."

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