Medicare Supplement Vs Medicare Advantage Pros and Cons
You qualify for a supplemental Medicare product if you have Original Medicare Parts A & B.
Medigap plans and Medicare Advantage offer you a way to cope with the out-of-pocket expenses not covered by Original Medicare.
The result is better predictability of your annual healthcare costs and peace of mind knowing you have full coverage for out-of-pocket expenses.
Medicare Advantage and Medigap plans are available from private healthcare insurers across America.
You have options available to suit any budget and coverage to take care of the healthcare expenses in the event of a medical emergency.
With Medicare Advantage and Medigap, you don’t have to worry about dipping into your retirement savings to cover unforeseen medical expenses.
So, what are the differences between Medicare Advantage and Medigap?
This examines the Medicare Supplement Vs Medicare Advantage pros and cons.
We’ll give you all the information you need to make an informed decision on the right policy for your unique healthcare situation.
Let Us Guide Your Decision on Medicare Supplement Vs Medicare Advantage Plans
If you find understanding the differences between Medicare Advantage and Medigap challenging, call us at 1-888-891-0229.
We offer a free consultation and quote on the right plan to meet your unique healthcare needs.
Our team of fully licensed agents can break down the differences in products and recommend the right plan for you.
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What’s the Difference Between Medicare Advantage Vs Medigap?
Medigap plans are supplemental policies designed to cover the out-of-pocket costs not covered by Original Medicare Parts A & B.
Medicare Advantage plans (Part C) replace your Original Medicare Parts A & B policies.
Medicare pays providers a set amount annually to carriers to make MA plans available.
There’s plenty of promotion of MA plans but little to none on Medigap policies.
If you’re looking for comprehensive care with no out-of-pocket costs, it’s a good idea to go with a Medigap policy.
However, if you’re a low-income senior, you might want to consider Medicare Advantage.
You can switch from Medicare Advantage to Medigap in the first year of taking a policy if you decide you want more coverage for your annual healthcare costs. Contact our team, and we’ll show you how.
Medicare Supplement Vs Medicare Advantage Pros and Cons
Medicare Supplement Plans Pros & Cons
- Low to zero out-of-pocket costs.
- A good range of plans to suit all medical needs and any budget.
- No medical referral is required.
- No medical underwriting in the open enrollment period.
- Ability to change plans anytime.
- Coverage out-of-state and internationally.
- Visit any practitioner or hospital in the Medicare network in all states.
- Federally standardized benefits on all plans.
- Higher monthly premiums than MA plans.
- Add-on plans for dental, vision, and prescriptions at an extra cost.
- No coverage for preventative care, long-term nursing, or private nursing.
Medicare Advantage Pros & Cons
- Beneficiaries get additional benefits like dental, vision, hearing, and prescriptions.
- Free plans or low premiums.
- Over 200 MA plan options.
- Higher out-of-pocket maximums (up to $10,000)
- Restrictions to hospitals and doctors in-network.
- No coverage out of service area or internationally.
- Most MA plans require medical referrals.
What Do Medicare Advantage Plans Cover?
All Medicare Advantage plans cover you for the following.
- Medicare Part A (hospital) benefits
- Hospice coverage is covered by Part A.
- All Medicare Part B benefits
- Prescription medications.
Additional Benefits Offered by Medicare Advantage Plans
- Dental exams and cleanings.
- Eye exams, contact lenses, and eyeglasses from selected providers.
- Hearing tests and hearing aids from selected providers.
- Gym memberships and wellness program discounts.
- Transportation to doctors’ appointments.
- Virtual consultations with medical providers.
*Original Medicare Part A will still pay for hospice care even if you have a Medicare Advantage plan.
- Some MA plans have provider networks, while others don’t.
- Out-of-pocket cost limitations vary depending on the plan you choose.
- Plan premiums vary to fit all budgets.
What Do Medicare Supplement Plans Cover?
All Medigap Plans offer beneficiaries the following benefits.
- Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
- Part A hospice care copayment or coinsurance.
- Part B copayment or coinsurance.
- The first three pints of blood are used in blood transfusions and medical procedures.
Plan F, G, and N Offer the following additional benefits for Medicare Parts A & B
- Part A deductible. ($226 in 2023)
- Part B excess charges (Plan N doesn’t cover this).
- Coinsurance for care at a skilled nursing facility
- 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply.
- Unlimited coverage for all out-of-pocket expenses (Plans K & L have limited coverage).
Medicare Supplement Vs Medicare Advantage – Differences in Premiums
There are over 200 MA plans, many of which come with zero-cost premiums. That means you get your coverage for free.
However, the zero-cost MA plans usually don’t come with additional perks or benefits, and you’ll probably be locked into using providers in a specific network.
You’ll also have to meet the Part B deductible before accessing the other healthcare benefits.
That means you might not be able to visit your normal doctor if you use an MA plan.
For those plans that charge premiums, the average price for MA plans in 2023 is $18, making it an affordable option for your healthcare coverage, especially for low-income seniors.
Medicare Supplement Insurance
Medigap premiums are set by each insurer using:
- your age,
- smoking status,
- and location.
These factors build your risk profile, and the insurer uses this to establish how much to charge you for your premium each month.
The biggest factor in premiums is your smoking status and location in the United States.
Of the two, the location risk is the most significant factor, and it can cause huge swings in premiums.
- For instance, a policy in Atlanta is much more affordable than one in Los Angeles. Premiums can also vary between providers.
- For example, AARP is the lowest-cost provider in many states and offers lower premiums than Aetna and Humana in most locations.
Our team can help you find the best price on your monthly Medigap premiums in your state.
Reach out to us, and we’ll help you save money on your Medigap policy.
Frequently Asked Questions
What is Medicare Supplement (Medigap) insurance?
Medicare Supplement insurance, also known as Medigap, is a type of private health insurance that helps cover the costs not paid by Original Medicare, such as deductibles, copayments, and coinsurance.
What is Medicare Advantage?
Medicare Advantage, also called Medicare Part C, is an alternative to Original Medicare offered by private insurance companies. It provides all the benefits of Original Medicare, and often includes additional coverage, such as prescription drugs, dental, and vision.
What are the pros of Medicare Supplement insurance?
Some pros of Medicare Supplement include freedom to choose any doctor or hospital that accepts Medicare, standardized plans for easy comparison, predictable out-of-pocket costs, and coverage for certain expenses not covered by Original Medicare.
What are the cons of Medicare Supplement insurance?
The cons of Medicare Supplement include higher monthly premiums compared to Medicare Advantage, the need to purchase separate prescription drug coverage (Part D), and no coverage for additional benefits like dental, vision, or hearing.
What are the pros of Medicare Advantage?
Medicare Advantage offers additional benefits beyond Original Medicare, such as prescription drug coverage, dental, vision, and hearing services.
It often has lower monthly premiums than Medicare Supplement plans, and some plans include coverage for fitness programs.
What are the cons of Medicare Advantage?
Some cons of Medicare Advantage include restricted networks of doctors and hospitals, potential referral requirements, copayments or coinsurance for services, limited coverage outside your plan’s service area, and the need to follow plan rules and procedures.
Which plan provides more flexibility in choosing healthcare providers?
Medicare Supplement plans generally provide more flexibility in choosing healthcare providers. With Medicare Supplement, you can see any doctor or specialist who accepts Medicare, without needing referrals or dealing with network restrictions.
Which plan typically has lower out-of-pocket costs?
Medicare Supplement plans typically have lower out-of-pocket costs compared to Medicare Advantage. While you pay higher monthly premiums with Medigap, your out-of-pocket expenses for services covered by your plan are generally lower.
Can I switch from Medicare Advantage to Medicare Supplement?
Yes, you can switch from Medicare Advantage to Medicare Supplement during certain enrollment periods. However, it’s important to note that switching may require medical underwriting, and you may not be guaranteed acceptance into a Medicare Supplement plan.
Which plan is better: Medicare Supplement or Medicare Advantage?
The better plan depends on individual needs and preferences. If you prefer more choice in doctors, lower out-of-pocket costs, and are willing to pay higher monthly premiums, Medicare Supplement may be a better option.
If you value additional benefits, lower monthly premiums, and can work within a network of providers, Medicare Advantage may be more suitable.
Medicare Supplement Vs Medicare Advantage - How to Apply
The easiest way to get started is to call us today at 1-888-891-0229.
We’ll answer all of your questions and help you find the right Medicare plan. Or you can use our FREE quote engine to begin shopping today!
Updated December 4th, 2022