Most people are aware of Original Medicare (Part A and Part B), but there can be some confusion when it comes to supplemental and alternative plans.
What are Medigap and Medicare Advantage plans?
Medicare Advantage plans are healthcare plans sold by private insurance companies. By law, the plan must offer the same benefits as Original Medicare, but the plans often come with extra benefits like dental, vision, hearing, and prescription drug coverage.
Medicare supplement (Medigap) plans fill the “gaps” in your Original Medicare coverage. This means a plan will often pick up the bill for out-of-pocket expenses like copays, deductibles, and coinsurance and is also sold by private insurance providers.
There are several different types of cost associated with Medicare:
- Premiums. Medigap premiums typically range between $100 and $250 per month. Medicare Advantage premiums can be anywhere from $0 to over $300.
- Copays. Medigap plans pick up copays you accrue from Original Medicare. You are subject to copays with Medicare Advantage.
- Deductibles. Medicare Advantage deductibles vary by plan; some are $0. Medigap plans do not cover the Medicare Part B deductible unless you purchased Plan F or Plan C before December 31, 2019 before these plans were phased out.
- Out-of-pocket costs. Medigap plans pick up the bill for out-of-pocket costs; you typically will not have any out-of-pocket costs with Medigap unless your healthcare is not covered by Original Medicare. Out-of-pocket costs vary by Medicare Advantage plan, but no plan can have a cap higher than $6,350 in 2020.
Medicare Advantage plans vary by county. If you live in a rural area, you may have fewer options for Medicare Advantage plans.
Medigap has 10 standardized plans across the United States, with the exception of Minnesota, Massachusetts, and Wisconsin, which have their own standard plans. Medicare announced in 2019 that it was phasing out its most popular plans–F and C. However, this is just for newly-eligible beneficiaries; everyone born before December 31, 2019 may purchase Medigap Plan F and Plan C indefinitely.
You do not need a referral to see a specialist if you have Original Medicare with a Medigap plan.
You may need a referral to see a specialist if you have an HMO Medicare Advantage plan; many PPO plans do not require a referral.
Ninety-nine percent of doctors, hospitals, and clinics in the United States accept Original Medicare. If you have Original Medicare with a Medigap plan, you may see any of these doctors. Medigap plans are beneficial to snowbirds who split their time between states or for beneficiaries who travel often.
Beneficiaries with Medicare Advantage plans may be subject to smaller networks of doctors and could be the victim of surprise medical bills.
Note: It is wise to call your insurance before a non-emergency appointment to verify that the doctor, hospital, or clinic is in your network.
It’s best to enroll in a Medigap plan during your initial enrollment period, or when you are first eligible for Medicare.
You can enroll in a Medicare Advantage plan or switch plans each year between January 1 and March 31.
If you have a Medigap plan with Original Medicare, you will also need to purchase a Medicare Part D prescription drug plan.
Many Medicare Advantage plans come with prescription drug coverage included.
- Medical underwriting. If you wait to purchase a Medigap plan or switch from one plan to another, you could be subject to medical underwriting. Medical underwriting is when an insurer can limit your coverage, deny your coverage, subject you to a waiting period, or charge you much higher rates.
- Must choose one or the other. You may not have a Medigap and a Medicare Advantage plan at the same time. It is illegal for a Medicare broker to sell you one plan while you have the other.
If you’re having trouble choosing between Medicare Advantage plans and Medigap plans, you can call your local State Health Insurance Assistance Program (SHIP) for free and unbiased advice about your Medicare options.