Medigap vs Medicare Advantage 2023

Compare affordable Medicare Plans

Medicare can be confusing when you first turn age 65. In fact, it can still be confusing afterward with so many TV commercials trying to get you to call them.

Even seasoned Medicare veterans are wondering if they should go with a Medicare Advantage or a Medigap plan in 2023.

 

Medigap vs Medicare Advantage key takeaways:

  • Medigap has no network and freedom to visit any doctor or specialist in the country that accepts Medigap.
  • Medicare Advantage has a network and provides at least the same coverage as Original Medicare Parts A and B
  • You must choose one or the other, you may not be enrolled in both

 

Medicare Advantage Plans

Medicare Advantage plans are popular because they offer some additional benefits over Original Medicare Part A and B alone. Many Medicare Advantage plans in 2023 may include additional benefits such as:

  •  Prescription drug coverage
  • Dental coverage
  • Hearing coverage
  • Vision coverage
  • Fitness benefits
  • Wellness benefits
  • Transportation

 

These benefits are not guaranteed in every plan, and plan benefits vary by company as well as in different parts of the country.

 

The Four Types of Advantage Plans

 

Medicare Advantage plans have 4 different types of plans, each slightly different.

 

They are:

  • HMOs – Health Maintenance Organization
  • PPOs – Preferred Provider Organization
  • PFFS – Private Fee-for-Service plans
  • SNPs – Special Needs Plans

 

HMOs

These plans have a network you must adhere to in order to get coverage, except in emergency situations. You must choose a primary care provider (PCP),  and you need referrals to see a specialist as well.

Many of these plans offer additional coverage such as prescription drug coverage, and some even have $0 monthly premiums.

 

PPOs

With a PPO you can see any approved doctor in-network, or out of network. Typically the monthly premiums are higher for these plans, and out-of-network visits may cost more in many cases.
Prescription drugs are covered in most PPO plans, and many plans may have additional benefits such as dental, vision, and hearing coverage.

 

PFFS 

PFFS plansWith Private-fee-for service plans, you can see any doctor in the country, provided they have signed on to accept the terms of the plan. You must check with your doctors to see if they accept the plan with all Medicare Advantage plans.

 

SNPs

SNP plansSpecial needs plans are offered to people who have certain medical conditions. You must qualify for these plans, and in most cases, you must be on both Medicare and Medicaid to be able to enroll in the plan.

Some conditions that are accepted are things like alcohol dependence, certain autoimmune diseases, end-stage renal disease (ESRD), HIV/Aids, and several more.

 

 

Medicare Advantage – Prescription Drug Coverage

 

Medicare part dMany insurance companies also include Medicare Part D drug coverage within their Medicare Advantage plans. Other things that can be covered include up to three pints of blood per year, and other costs associated with doctor appointments, hospital visits, and emergency care.

 

You will have the ability to choose the amount of coverage needed. Remember that each insurance company has it’s own set of plans, and each plan has entirely different benefits. 

Because of this, shopping for the right plan can get very confusing. The good news is, that we can help! You can shop for plans right here on this site, or call one of our licensed agents now to get help.

 

 

Medicare Advantage plan enrollment

 

As mentioned above, Medicare Advantage was designed as an alternative to Original Medicare.

You will have to be enrolled in both Medicare Part A and B prior to enrolling in an advantage plan, and even though you are opting out of Original Medicare you must still pay the Medicare Part B premium each month. 

Medigap also requires you to have Part A and Part B, but it is based completely on Medicare coverage.

 

Medicare Part A and B

Unless you qualify for Medicare first, you will not be allowed to enroll in either one of these plans. To qualify you must be a U.S. resident and have worked at least 40 quarters in your lifetime, or you qualify for Social Security disability for at least 24 months.

 

Another area to consider when comparing Medicare Advantage vs Medigap in 2023 is that there are hundreds of different plans available in most states.

We make it easy to compare the plans and benefits, and you can even enroll online using our website!

 

Medicare supplement rates

 

 

Medigap plans

Medigap – No Network and Few out-of-pocket costs

With Medigap insurance, you keep Original Medicare (Part A and B), and unlike Medicare Advantage plans there is no network that you must stay in.

Medigap plans are accepted anywhere in the country as long as the provider accepts Medicare, and you don’t need a referral for a specialist.

Medigap Plans - (Medicare Supplement Plans)

There are currently 12 Medigap plans available. These plans help pay the “gaps” in Medicare Part A and B.

These gaps are expenses such as:

  • Copays
  • Deductibles
  • Coinsurance

You are responsible for paying these, however, a Medigap plan can pay most of them for you.

The most popular Medigap Plans are:

  • Plan G
  • Plan N
  • Plan F*

*Only those who were enrolled in Medicare prior to January 1st of 2020 may be enrolled in a Medigap Plan F

Medigap plans

Medicare Supplement Plan G

Medicare Plan G

Medicare Plan G is now the highest-coverage Medigap Plan for people new to Medicare.

It has outstanding coverage with only one small deductible to pay. This is the annual Medicare Part B deductible, and in 2022 it was $233. It should be close to that in 2023.

Once this deductible is paid you get 100% coverage of all Medicare-approved expenses both in the hospital as well as outpatient services.

Medicare supplement quotes

Medicare Supplement Plan N

Medicare Plan N

Medicare Plan N is also a great plan, with lower monthly premiums than Plan G.

This is because with Plan N you might have some additional out-of-pocket expenses to pay vs. Plan G.

On Medigap Plan N, you still pay the annual Medicare Part B deductible just like you would on Medicare Plan G. After this is met:

  • You might have a co-pay of up to $20 per doctor’s visit (telehealth visits do not apply
  • You will have a $50 co-pay if you visit the emergency room and you’re not admitted
  • Plan N doesn’t cover Medicare Part B excess charges (rare)
Medicare Plan N Rates

Pros and Cons of Medigap vs Medicare Advantage

Below are the pros and cons of Medigap vs Medicare Advantage to help you decide which one fits your needs best.

The easiest way to see which plan is right for you is to give us a call today at 1-888-891-0229.

 

Medicare Advantage Plans Pros

  • Low monthly premiums, sometimes $0/month
  • Plans often include prescription drug coverage
  • May have additional benefits such as dental/vision/hearing, wellness programs, fitness benefits, and more (benefits vary by plan)
  • Reduced costs for staying in-network

 

Cons:

  • Must stay in-network to get the lowest cost
  • Need a referral for a specialist who must be in-network
  • You do not have the luxury of seeing any doctor or specialist in the country such as with Medigap
  • Plans have a max out-of-pocket of up to over $8000 in 2023 (You can be billed up to the plans max out-of-pocket)
  • Prior authorization is needed for various procedures, unlike a Medigap plan

 

 

Medigap Plans – Pros

  • No network! See any doctor, specialist, or hospital in the country that accepts Medicare
  • No referrals are needed to see a specialist. Just call and make an appointment
  • Low deductibles and low monthly premiums
  • No max out-of-pocket costs
  • No prior authorization is needed, and no claims are denied
  • If Medicare pays first, the plan must pay the difference

 

Cons:

  • Medigap plans do not include prescription coverage or any additional benefits

Getting Started

The easiest way to get started and get all your questions answered is to give us a call today.

Our licensed agents can help you decide which plan is best for you now, and for years to come. And our service is entirely FREE.

Medicare supplement quotes