by Russell Noga | Updated December 11th, 2023
If you have Original Medicare Parts A & B, then you qualify to apply for a Medicare Supplement plan.
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.
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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
Medicare Advantage
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
- X-rays.
- 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.
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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
Medicare Advantage
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, gender, 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.
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Frequently Asked Questions
What is the difference between Medicare Supplement and Medicare Advantage?
Medicare Supplement, also known as Medigap, is private health insurance that works alongside Original Medicare to help cover out-of-pocket costs such as deductibles, copayments, and coinsurance. Medicare Advantage, on the other hand, is an all-in-one alternative to Original Medicare offered by private insurance companies, providing Medicare Part A, Part B, and often additional benefits.
What are the pros of Medicare Supplement plans?
Pros of Medicare Supplement plans include the ability to choose any doctor or hospital that accepts Medicare, no network restrictions, comprehensive coverage for out-of-pocket costs, predictable costs and coverage, and the option to keep your coverage when traveling within the United States.
What are the cons of Medicare Supplement plans?
Cons of Medicare Supplement plans include the need to pay a separate premium in addition to your Medicare Part B premium, limited coverage for prescription drugs (requires a separate Part D plan), and the lack of additional benefits like dental, vision, and hearing.
What are the pros of Medicare Advantage plans?
Pros of Medicare Advantage plans include the potential for lower monthly premiums compared to Medicare Supplement plans, inclusion of additional benefits like prescription drug coverage, dental, vision, and hearing services, and often bundled coverage for hospital, medical, and prescription drug expenses.
What are the cons of Medicare Advantage plans?
Cons of Medicare Advantage plans include being restricted to a network of healthcare providers, potential for higher out-of-pocket costs like copayments and coinsurance, and the need to obtain referrals to see specialists.
What is the difference in coverage between Medicare Plan G and Plan N for Medicare Supplement?
Medicare Plan G provides comprehensive coverage for Medicare Part A and B deductibles, excess charges, and skilled nursing facility coinsurance. Plan N has similar coverage but requires cost-sharing in the form of copayments for certain services, such as office visits and emergency room visits.
Can I switch between Medicare Supplement and Medicare Advantage plans?
Generally, you have the flexibility to switch between Medicare Supplement and Medicare Advantage plans during specific enrollment periods. However, it’s important to note that if you switch from Medicare Supplement to Medicare Advantage, you may face medical underwriting when returning to a Medicare Supplement plan in the future.
How do I decide between Medicare Supplement and Medicare Advantage?
The decision between Medicare Supplement and Medicare Advantage depends on your individual needs and preferences. Consider factors such as your healthcare needs, budget, desired level of flexibility in choosing healthcare providers, willingness to pay out-of-pocket costs, and the availability of additional benefits.
Can I have both Medicare Supplement and Medicare Advantage plans?
No, you cannot have both Medicare Supplement and Medicare Advantage plans simultaneously. It’s important to choose one option that best aligns with your healthcare needs and goals.
Where can I get assistance in comparing Medicare Supplement and Medicare Advantage plans?
To compare Medicare Supplement and Medicare Advantage plans, it’s recommended to consult with licensed insurance agents specializing in Medicare. They can provide personalized guidance, help you understand the pros and cons of each option, and assist you in finding the most suitable coverage for your healthcare needs.
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. If you can’t speak right now, fill out the contact form on this site, and We’ll have an expert call you back to discuss your healthcare requirements.
Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.