by Russell Noga | Updated September 15th, 2023
Navigating the world of Medicare can be overwhelming, especially when you’re faced with the choice between Medicare Advantage and Medigap plans.
One question that often arises is, “Is Medicare Plan G an Advantage plan?”
In this article, we’ll explore the differences between these two types of plans, their coverage, costs, and provider networks.
By the end, you’ll be armed with the knowledge you need to make an informed decision and choose the plan that best meets your needs and preferences.
- Understanding the differences between Medicare Advantage and Medigap is essential for selecting a suitable plan.
- Medicare Plan G is a comprehensive Medigap policy that does not qualify as an Advantage plan due to its lack of coverage for Part B deductible.
- Financial, provider preference, and personal health needs should be taken into consideration when making the decision between these two plans.
Understanding Medicare Advantage and Medigap
When it comes to supplementing Original Medicare coverage, you have two primary options: Medicare Advantage and Medicare supplement plan.
While both are designed to help you manage healthcare costs and services, they differ in significant ways. Medicare Advantage plans are comprehensive packages that often include prescription drug coverage and dental coverage, while Medicare supplement plans serve as supplementary coverage that works alongside your Original Medicare benefits.
Understanding the key differences between these two options is crucial for choosing the plan that best suits your needs.
What is Medicare Advantage?
Medicare Advantage plans, or Part C, are a type of plan offered by private insurance companies. They provide an alternative to Original Medicare.
They bundle coverage for Part A (hospital insurance) and Part B (medical insurance) services, often including additional benefits such as vision, dental, and hearing coverage.
With over 30 Medicare Advantage plans available to the average beneficiary, there is no shortage of options to choose from.
However, the cost of Medicare Advantage can vary depending on factors such as the plan, age, and location.
What is Medigap?
On the other hand, Medigap policies are Medicare Supplement Insurance plans designed to help cover out-of-pocket costs not paid for by Original Medicare.
These plans, also offered by private insurance companies, provide additional benefits for expenses such as hospital and doctor visits, lab tests, and durable medical equipment.
There are ten standardized Medigap plans (A, B, C, D, F, G, K, L, M, and N) to choose from, with Plans F and G also offering high-deductible versions in certain states.
The optimal time to purchase a Medigap policy is during the six-month open enrollment period that begins when you turn 65 and enroll in Medicare Part B.
Is Medicare Plan G an Advantage Plan?
One common question that arises is whether Medicare Plan G is an Advantage plan. The answer is no. Plan G is a popular Medigap policy that helps cover the out-of-pocket costs not paid for by Medicare after it has paid its portion of the bill.
It provides nearly the same level of coverage as Plan F yet does not cover the Medicare Part B deductible.
Let’s delve deeper into the nature of Plan G and why it is not considered an Advantage plan.
Medicare Plan G: A Medigap Policy
Medicare Plan. G is a widely utilized Medigap policy that covers the majority of out-of-pocket expenditures, apart from the Part B deductible.
Once the Part B deductible of $233 is paid, Plan G covers almost all out-of-pocket expenses for services and treatment, meaning no copays or coinsurance are required.
Those who are eligible for Original Medicare may be able to enroll in Plan G, with costs ranging from $99 to $476 per month, depending on the individual and location.
Why Plan G is not an Advantage Plan
The key distinction between Medicare Supplement Plan G and Medicare Advantage plans lies in the fact that Plan G supplements Original Medicare rather than replacing it.
While Medicare Advantage plans provide comprehensive coverage with supplementary advantages, they have network limitations which may restrict the choice of healthcare providers.
In contrast, Medigap plans like Plan G offer more adaptability and help cover out-of-pocket expenses, allowing beneficiaries to see any doctor who accepts Medicare.
Comparing Coverage: Medicare Advantage vs. Medigap Plan G
Now that we have established the differences between Medicare Advantage and Medigap Plan G, let’s compare the coverage each option provides.
While both types of plans aim to help Medicare beneficiaries manage healthcare costs and services, they offer varying levels of coverage.
Understanding the extent of coverage provided by each option can help you make an informed decision about which plan is best suited to your needs.
Medicare Advantage Coverage
Medicare Advantage plans provide coverage for all Original Medicare services. Some Advantage plans may offer extra coverage such as:
- Prescription drugs
- Wellness services
This coverage, offered by an insurance company, often comes with the trade-off of limited provider networks and the need to select physicians and hospitals within the plan’s network to keep costs low.
However, the convenience of having all healthcare services bundled under one plan may be appealing to some beneficiaries.
Medigap Plan G Coverage
In contrast, Medigap Plan G offers extensive coverage for most out-of-pocket costs associated with Original Medicare, providing beneficiaries with more predictable expenses. Plan G covers costs such as:
- Excess charges for Part B services
- Hospitalization costs for an additional 365 days after Medicare benefits are used up.
However, it’s important to note that Plan G does not cover the Part B deductible, which must be paid separately.
Costs and Out-of-Pocket Expenses
The cost of health insurance is a significant concern for many Medicare beneficiaries, and it’s essential to compare the costs and out-of-pocket expenses associated with Medicare Advantage and Medigap Plan G. While both types of plans aim to help manage healthcare costs, they can vary in terms of:
- network restrictions
It’s important to carefully consider these financial aspects when choosing between Medicare Advantage and Medigap Plan G.
Let’s take a closer look at the costs and out-of-pocket expenses of each option.
Medicare Advantage Costs
Medicare Advantage plans may pay monthly premiums; however, it’s essential to consider other expenses, such as copays, deductibles, and out-of-pocket maximums, which can vary significantly between plans.
Additionally, Medicare Advantage members are still required to pay the standard Part B premium.
Medigap Plan G Costs
In comparison, Medigap Plan G typically has higher premiums but lower out-of-pocket costs, offering more predictable expenses for beneficiaries.
The premiums for Plan G can vary depending on factors such as the insurance provider, the plan, and the geographic location.
However, it’s important to note that Medigap Plan G does not cover Part B premiums, which must be paid separately.
Overall, the decision between Medicare Advantage and Medigap Plan G will depend on your financial situation and healthcare needs.
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Provider Networks and Flexibility
Another essential factor to consider when choosing between Medicare Advantage and Medigap Plan G is the availability of healthcare providers and the flexibility in selecting them.
Medicare Advantage plans often have limited provider networks, restricting the choice of doctors and hospitals, while Medigap Plan G offers greater flexibility, allowing beneficiaries to see any doctor who accepts Medicare.
Let’s explore the differences in provider networks and flexibility between these two options.
Medicare Advantage Provider Networks
Medicare Advantage plans, such as Medicare Advantage HMO, often feature limited provider networks, requiring beneficiaries to utilize physicians and hospitals within the plan’s network for lower costs.
This can be a significant drawback for those who prioritize the freedom to choose their healthcare providers.
HMOs, for instance, require members to use physicians and hospitals within their networks, while PPOs usually allow members to receive care outside the plan’s network, but there may be higher out-of-pocket costs.
Medigap Plan G Flexibility
In contrast, Medigap Plan G provides more flexibility when it comes to selecting healthcare providers.
Beneficiaries can visit any doctor or specialist who accepts Medicare without any network limitations.
This can be particularly beneficial for those who travel frequently or require specialized care from providers outside of a restricted network.
The freedom to choose your healthcare providers can be a deciding factor when weighing the benefits of Medicare Advantage and Medigap Plan G, offered by private health insurance companies.
Making the Right Choice: Factors to Consider
Choosing between Medicare Advantage and Medigap Plan G ultimately comes down to assessing your personal healthcare needs, financial situation, and preferences. By examining the coverage, costs, provider networks, and flexibility of each option, you can make an informed decision about which plan is best suited to your needs.
Let’s discuss some key factors to consider when making your choice. These include the coverage offered, the cost of the plan, the provider network, and the flexibility of the plan.
When comparing Medicare Advantage and Medigap plans, it’s essential to consider the costs of premiums, copays, and out-of-pocket expenses.
While Medicare Advantage plans may have lower premiums, they could come with higher out-of-pocket costs, depending on the plan.
On the other hand, Medigap Plan G typically has higher premiums but lower out-of-pocket costs, offering more predictable expenses for beneficiaries.
It’s crucial to weigh these financial factors when choosing the plan that best meets your needs.
Healthcare Provider Preferences
Another essential factor to consider is the importance of being able to choose your healthcare providers and the availability of in-network doctors.
As discussed earlier, Medicare Advantage plans often have limited provider networks, while Medigap Plan G offers greater flexibility, allowing beneficiaries to see any doctor who accepts Medicare.
When making your decision, consider whether the freedom to choose your healthcare providers is a priority for you.
Personal Health Needs
Lastly, it’s essential to assess your personal health needs when selecting a plan. Consider any chronic conditions or required treatments, as well as your lifestyle and the amount of travel you do.
Medicare Advantage plans may offer more comprehensive coverage, including additional benefits not offered by Original Medicare, while Medigap Plan G covers most out-of-pocket costs associated with Original Medicare.
By taking your personal health needs into account, you can choose the plan that best meets your individual requirements.
Switching Between Medicare Advantage and Medigap
It’s worth noting that switching between Medicare Advantage and Medigap plans is possible, but the process can be complicated and may involve changes in coverage, provider networks, and costs.
If you’re considering switching between these two types of plans, it’s important to be aware of the potential implications and the steps involved in the process.
It’s important to research the different plans available and understand the differences between them before making a decision.
Switching from Medicare Advantage to Medigap
Switching from Medicare Advantage to Medigap may be possible during specific enrollment periods, such as the Medicare Advantage Open Enrollment Period (October 15th to December 7th) or the Medigap Open Enrollment Period (six-month period starting the month you turn 65 and enroll in Medicare Part B).
However, this transition could result in higher premiums or medical underwriting, depending on your health status and the Medigap plan you choose.
Switching from Medigap to Medicare Advantage
On the other hand, switching from Medigap to Medicare Advantage requires waiting for the Open Enrollment period mentioned earlier.
This transition may involve changes in coverage and provider networks, as Medicare Advantage plans often have limited networks and varying levels of coverage compared to Medigap plans.
It’s essential to carefully consider these changes before making the switch.
In conclusion, choosing between Medicare Advantage and Medigap Plan G is a personal decision that depends on your unique healthcare needs, financial situation, and preferences. By considering the coverage, costs, provider networks, and flexibility of each option, as well as your personal health needs and provider preferences, you can make an informed decision and select the plan that best meets your requirements.
Remember, the key to making the right choice is to weigh the pros and cons carefully and prioritize what matters most to you in your healthcare journey.
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Frequently Asked Questions
Is Plan G the same as advantage?
Medicare Advantage plans offer additional benefits that Medigap Plan G does not, so they are not the same.
Medicare Advantage plans provide more than just coverage for Parts A and B services.
What is the advantage of Plan G?
Plan G provides comprehensive coverage for Medicare Part A and B, including hospital inpatient costs, coinsurance/copays, skilled nursing facility care, hospice care, and more.
Furthermore, it covers all these services 100% after the Medicare Part B deductible is paid.
What is a Medicare Plan G?
Medicare Plan. G is a supplemental policy that covers certain expenses such as coinsurance, copayments and deductibles not covered by Medicare Part A and Part B.
It includes all the benefits of Plans A, B and C with the exception of the Medicare Part B deductible, offering comprehensive coverage at an increased cost.
What are the main differences between Medicare Advantage and Medigap?
Medicare Advantage provides additional benefits not included in Original Medicare, while Medigap serves as supplementary coverage to supplement Original Medicare.
When can I switch from Medigap to Medicare Advantage?
You can switch from Medigap to Medicare Advantage during the annual Open Enrollment period, running from October 15th to December 7th.
Get an Immediate Quote and Advice on Medicare Supplement Plan G
If you want to skip ahead and get right down to business, contact our team at 1-888-891-0229. We offer professional advice on Plan G.
We’ll show you the best insurers in your state and calculate the most affordable premium for your unique situation. Or fill out the contact form on our site, and we’ll have an expert get back to you for a free consultation.
Russell Noga is the CEO of Medisupps.com, an online Medicare Agency and resource center helping Medicare beneficiaries learn about Medicare, Medigap and Part D drug plans, and Medicare Advantage plans since 2009. Russell is licensed in all 50 states and has been featured as a keynote speaker, and author of several publications, along with hosting the very popular Medisupps.com Youtube channel.