As we approach 65 years old and face the challenge of understanding Medicare with all of its layers, one critical understanding involves the difference between Medigap and Medicare Advantage. The link from nerdwallet HERE explains it in detail, and our highlights below should motivate you to want to read the whole article!
“The biggest difference between Medigap and Medicare Advantage is that with a Medigap plan, you have the freedom to see any doctor that accepts Medicare, whereas with Medicare Advantage, you must get care within the plan’s network of doctors and hospitals unless it’s an urgent or emergency situation.”
Other points to highlight:
Consider an Original Medicare plan with MEDIGAP if you:
a) want to see any doctor: Some people may face diseases that are not easy to treat, and you would want to be able to choose your provider.
b) intend to travel: you can see any provider in the country that accepts Medicare… the Advantage plans come with limited service areas and doctors.
c) have a chronic condition or receive frequent medical care: the Medigap plan premium covers you for many out-of-pocket costs that come with seeking frequent care vs the Advantage plan where the out-of-pocket maximum for in-network care can be as high as $8,850 in 2024
d) like to play it safe: in a worst-case scenario, if you’re diagnosed with a serious condition later in life, you may want to get care from the best specialists, who may or may not take your Medicare Advantage plan. You also may be surprised by the costs that add up among all the fees not covered by the Advantage plan vs the larger range of covered costs in the Medigap plan.
Consider Medicare Advantage if you:
a) have an extensive network of doctors where you live
b) cannot afford Medigap or
c) prefer managed care plans.
Medigap notes to keep in mind:
- Medigap (which is supplemental insurance to Medicare), is something you can enroll in on only TWO occasions. One is during the six-month period that starts the month you’re 65 or older and obtain Medicare Part B and you can get a Medigap policy NO QUESTIONS ASKED. After that point, you may have to go through medical underwriting to get a policy, which could result in a higher price or denial of coverage if you’re in poor health. The other occasion is if the loss of your Medicare Advantage policy is involuntary, like if you change zip codes or the company decides not to renew that particular plan.
- Medigap is sold by private companies, & fills the “gaps” in Original Medicare by covering certain out-of-pocket expenses, such as deductibles and copays. The Medigap monthly premium is paid up front (with the Medicare Plan costs you have enrolled in) but then everthing is covered.
- Medigap allows you to see any doctor you choose as long as they accept Original Medicare.
Medicare Advantage notes to keep in mind:
Medicare Advantage is an alternative to Original Medicare that includes Medicare Part A and Part B, usually Part D (prescription drugs), and often extra benefits such as some dental, vision and hearing coverage. You become eligible for Medicare Advantage initially during your 65th birthday month, plus the three months before and after. After that, you can change plans during Medicare open enrollment, which happens from Oct. 15 to Dec. 7 each year, or during Medicare Advantage open enrollment, which occurs from Jan. 1 to March 31 each year. You may also be able to switch plans if you qualify for a special enrollment period, such as when you’ve moved out of your plan’s service area or moved into a skilled nursing facility.
Medicare beneficiaries must still pay their Part B premium, which is $174.70 per month in 2024, along with the monthly premium for their Medicare Advantage plan. That said, many Medicare Advantage plans offer a $0 premium.