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The Choice – Medigap vs Medicare Advantage

When people first go on to Medicare they don’t tend to understand that they are not getting comprehensive coverage from the program.  When they realize the gaps left by Medicare is when we start to hear from them looking for a solution to the potential large medical bills.  This is where we can help you look at the difference of Medigap vs Medicare Advantage plans.  If you are already an expert in Medicare and are ready to get started with a set of quotes you can use the contact form on this page.  If you are here as a self learner this page will walk you through the gaps in Medicare and the two options for filling those gaps.

What are the gaps in Medicare?

Medicare has been a well-received program for seniors.  Making health insurance affordable for people who would not typically be able to purchase insurance is an important part of honoring our seniors.  What people do not tell you is that there are very specific gaps in Medicare.  These nine coverage gaps are:

  • Medicare Part A Deductible of $1,184
  • Medicare Part A Coinsurance
  • Medicare Part B Deductible of $147
  • Medicare Part B Coinsurance of 20%
  • Medicare Part B Excess Charges
  • Hospice Care Coinsurance
  • Skilled Nursing Care Coinsurance
  • Cost of the First Three Pints of Blood
  • Out of Country Emergency Coverage

These nine Medicare coverage gaps are of great concern to people on a fixed income.  On top of these there is no coverage for prescription drugs.  So while you only pay your Medicare Part B deductible you are not getting complete coverage.  Because of these gaps in coverage other options were created to give people greater benefits and thus comprehensive coverage.  This is where the decision between Medigap and Medicare Advantage has to be made.  To figure out which one is right for you we will explore each of the two options.

Medigap Plans – Enhancing Medicare Coverage

Medicare supplement plans were created to fill the specific gaps that we detailed above.  In most states there are ten total plans and each plan covers a different number or combination of the nine Medicare coverage gaps.  The most comprehensive of the ten plans is Medigap Plan F and you can learn more about Medigap plan F HERE.  Medigap plans were designed to work with your Medicare coverage.  This means that whereve Medicare is accepted so is your Medigap policy.  The premiums do vary based off of how much coverage you are receiving so picking the right plan is based off of which gaps you are comfortable with not covering.          Finally Medigap plans do not cover prescription drugs.  You will have to get a Medicare Part D plan to fill that gap.   Now to make a clear choice between Medigap vs Medicare advantage let’s look at Medicare advantage plans.

Medicare Advantage Plans – Private Health Insurance Option

Medicare Advantage was created to give Medicare recipients a choice between the government run Medicare plans and private health insurance.  These plans vary greatly from plan to plan and many even include prescription drug coverage.  The down side is that you really have to pay attention to what your plan covers and to the cost.  For instance, some of the plans with less coverage have no monthly premiums, but if you were to have a long hospital stay you could be left with some hefty bills.  You may get another plan with large premiums that offers way more coverage than you need.  So it is important when choosing to know exactly what you are getting Learn about the different Medicare Advantage plans HERE).  Finally, not every area offers coverage from Medicare Advantage so make sure that they are available to you

Making your Decision

There is no real best bet for each person when doing a comparison Medigap vs Medicare Advantage.  So the best bet is to get a set of quotes that are specific to you.  Your doctor options, and preference of program will play big rolls on which one you choose.  You can begin your search by using the form on this page and we will be happy to help you through the process of making this decision.