Comparing Medigap to Medicare Advantage (Part C)

Comparing Medigap to Medicare Advantage (Part C)

Medigap (Medicare Supplement) plans and Medicare Advantage (Medicare Part C) plans can look similar at first, but they have numerous differences.

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When you buy a Medigap plan, you get your benefits from Original Medicare (Part A and Part B), and the Medigap plan covers the out-of-pocket costs associated with Original Medicare benefits.

When you are part of a Medicare Advantage (Part C) plan, you get your benefits from that plan instead of the federal Medicare program. These plans must provide at least the same amount of coverage as Original Medicare (Part A and Part B), but may offer additional benefits.

Medigap Pros and Cons

If you have Medigap insurance you are able to visit any provider that allows Original Medicare patients. Medigap policies may have low monthly premiums, additional benefits like dental or vision, doctor supervision, and are available to all entitled individuals.

The benefits of a Medicare Supplement plan can include

  • Minimal to no cost for Medicare-covered services, depending on the plan

  • Freedom to use the plan nationwide (except for Medicare SELECT plans)

  • No medical underwriting if the plan is purchased during the Medigap Open Enrollment Period.

The Disadvantages of a Medicare Supplement plan can include

  • Drug coverage isn’t included, but you can add this through a separate Medicare Part D plan.

  • Medical underwriting can be required, except during the Medigap Open Enrollment Period, with some exceptions.

  • Depending on the state, plan choices may be limited and more expensive for individuals under 65

Medicare Advantage (Part C) Pros and Cons

These plans must provide at least the same amount of coverage as Original Medicare (Part A and Part B), but may offer additional benefits. Plan benefits and pricing vary widely.

The Advantages of a Medicare Supplement plan can include

  • Drug coverage is included with most of these plans

  • Managed care, such as supervision of doctors by the plan, possible case management, sometimes a 24-hour nurse hotline

  • Availability to all individuals entitled to Medicare Part A and enrolled in Medicare Part B who reside within the service area.

  • Possible additional benefits, such as routine dental and vision, and health club membership

The Disadvantages of a Medicare Supplement plan can include

  • Cost sharing and copayments for most many services

  • Physician network restrictions

  • Possible geographic restrictions

  • Possible requirement of referrals for specialist visits