Medigap vs Medicare Advantage: Which Is Better

Medigap and Medicare Advantage are two important Medicare options. Medicare Advantage integrates all Medicare parts into one plan.

Medigap insurance covers Parts A and B out-of-pocket expenses. But Medicare benefit restricts beneficiaries from choosing just one option at a time. We have simplified the key aspects below to help you better understand Medicare Advantage and Medigap.

What Is Medigap?

Medigap is a supplement to Medicare’s coverage for medical expenses. After deductibles, Medicare participants pay 20% of allowable expenditures. Medigap policies from private insurers cover copays and other Medicare-not-covered services.

Medigap provides ten plan choices, more than Original Medicare. And eight of these plans were for seniors who joined after January 1, 2020. When you reach 65, prices and eligibility may be higher for six months.

In certain regions, seniors under 65 may acquire Medigap, although monthly payments may be higher. A Medigap plan that covers everything is called Plan F, which is the most premium.

Most Medigap policies provide the following:

  • Medicare covers part A coinsurance and hospital expenses
  • The copayment or coinsurance for Medicare Part B
  • Coinsurance or copayments for hospice treatment under Part A
  • Three-pint blood transfusions

Medigap does not cover the following: 

  • Drugs prescribed by doctors
  • ophthalmology or dentistry
  • Aids to hearing
  • Eyeglasses
  • Nursing on-call for the general populace
  • Care for the long term

What Is Medicare Advantage? 

MA (also known as MA or Part C) is a kind of Medicare that combines original Medicare additional benefits. Part D is included in most Medicare Advantage plans (prescription drug coverage).

Choosing between a typical HMO or PPO and a Medicare Part C plan is an option available to you. Best Medicare advantage plans include in-network services and physicians; some allow out-of-network visits. Vision and dental care are standard extras included in many plans.

However, there may be network limits and referral requirements. Like Medigap, Medicare Advantage is sold by government-approved commercial insurers.

You must search for the ‘best advantage plan Medicare’ program near you to know the necessary details. State-wise, information on eligibility, pricing, etc., may differ.

For example, Medicare Advantage plans in Texas will cost an average of $10.68 per month in 2022. So, people in Texas should search for details on ‘Medicare advantage in Texas‘. They will come to know how to apply for Medicare along with other essential facts. Apply the exact strategies to locate the best advantage Medicare plan in other states.

Medicare Advantage covers the following fees beyond standard Medicare: 

  • Vision
  • Hearing
  • Wellness Programs
  • Dental

Medicare Advantage plans can be changed to include chronic illness or condition expenses. In addition to the above, Medicare Advantage plans may pay for the following: 

  • Transportation services for medical appointments
  • Medications available without a prescription
  • Services for caring for older adults daily

Part D prescription medication coverage is available with most Medicare Advantage plans. You may enroll in a separate program if your plan doesn’t cover prescription drugs. 

What Medicare Advantage does not cover- 

  • Copays
  • Coinsurance
  • Deductibles

Note 

If you have Medigap coverage, you cannot enroll in Medicare Advantage. However, you can move between the two during specified enrollment periods.

Differences Between Medigap and Medicare Advantage

Both Medigap and Medicare Advantage plans could be helpful, but they are different. A better understanding of these distinctions can help you choose the best Medicare benefit plan.

1. In the Matter of Medical Practitioners

Your choice of Medicare Advantage or Medigap may depend on the provider networks. Be aware of both plans’ restrictions if you have a long-term medical condition that necessitates regular visits. Medicare Advantage’s network contains few physicians and hospitals.

Several Medicare Advantage plans exclude out-of-network doctors from coverage. There are more options in some Medigap plans than others.

2. Price

Cost is the most significant difference between Medigap and Medicare Advantage coverage. In general, Medigap rates are more expensive than Medicare Advantage premiums. From 2022, the average monthly premium for a Medigap policy is $163.

Medicare advantage plan cost may offer more significant out-of-pocket expenditures than Medigap. Monthly Medicare Advantage premiums in 2021 were expected to be $21.22. It is going to be $19 a month starting in 2022.

Even though this is the average, some premiums are free, and others are far over one hundred dollars. You may save money if you choose a plan that works best for your health and financial situation.

3. Place Wise

Consider your location and lifestyle while choosing a plan. Your most incredible option is finding the best Medicare advantage plans if you reside in the same state and seldom travel. If you often travel or live in more than one state throughout the year, Medigap could be a viable choice.

Medicare Advantage programs often cover a limited region. As a result, they don’t usually cover overseas travel. On the other hand, Medigap plans are available throughout the country and internationally.

What Benefits Does Medigap Has to Offer?

  • Medicare supplement Medigap fills in coverage “gaps” and gives more comprehensive alternatives. This plan covers out-of-pocket expenses under the original Medicare plan.
  • In terms of the doctor network, it also provides a great degree of freedom. Medigap covers all Medicare-accepting doctors and hospitals. Medicare Advantage’s network of physicians and hospitals is much smaller.
  • Medigap also has the benefit of requiring less effort to file a claim. Almost little documentation is needed. Providers and facilities get payments in the mail once Medicare has paid its portion of the bill.

What Benefits Does Medicare Advantage Have to Offer?

  • Medicare Advantage supplements Original Medicare with extra benefits. This option is quite popular as a replacement for the Original Medicare Plan. For those who don’t expect to use it regularly, it’s a viable alternative to Medigap. Many plans cover the whole year if you surpass the out-of-pocket limit.
  • Enrollment in a Medicare Advantage plan is very straightforward, which is a huge plus. You may enroll in the best advantage Medicare plan after you have Original Medicare. Enrollment happens once a year.
  • Plan D, or prescription medication coverage, is included in most Medicare Advantage plans. Medigap, on the other hand, does not cover prescription drugs. The covered individual must purchase a separate prescription plan.

Why Should You Ch~oose Medicare Advantage Plans Over Medigap?

Medicare Advantage programs cost less than Medigap insurance. Changing plans is easier with them and often comes with extra perks like gym memberships.

What should you know about Switching From Medigap to Medicare Advantage? From October 15 until December 7, you may switch from Medigap to Medicare Advantage. 

Final Words 

It’s important to remember that you can only have one sort of Medicare benefit at a time. If you or your spouse are military retirees with alternative health insurance, you may not need Medicare Advantage or Medigap. Before signing up for Medigap coverage, determine whether you already have one. 

After choosing the best plan, find out how to apply for Medicare.