What is the Difference Between Medigap Plans and Medicare Advantage?
While they may seem similar in benefits, it is important that you understand that there is a difference between Medigap Plans and Medicare Advantage. Also known as Medicare Part C, a Medicare Advantage Health Plan is more similar to a traditional private insurance health plan. With this type of plan, the subscriber would enroll through a private insurance company instead of paying for Parts A, B, and D separately. In some instances, this would cover all of the benefits provided by Parts A, B, and D along with extra services and advantages.
The majority of the available Medicare Advantage Health Plans provide services such as office visits, lab tests, and surgeries with a small copay. Some plans may even give you the option of signing up for an HMO or PPO network plan while also limiting what you pay out of pocket.
Each Medicare Advantage Plan has unique rules and advantages. For example, while most plans deliver prescription drug benefits, some plans may necessitate that you have a referral when you want to see a specialist. Depending on the plan, it may only cover physicians and clinics that are a part of their network of providers. This makes it more difficult to figure out your coverage limits and benefits as opposed to a supplemental Medigap Plan.
Deciding to go with a Medigap Plan will usually result in a higher premium, but lower out of pocket costs when compared to most Medicare Advantage Health Plans. Another factor to consider is your lifestyle. Because Medicare Advantage Health Plans are offered regionally, a Medigap Plan is usually a better choice for snowbirds who frequently change residences or for people who tend to travel a lot.
Note that it is illegal for a company to try to sell you both a Medigap Plan and a Medicare Advantage Health Plan at the same time.
One of the biggest advantages of the specific Medigap policies is that clients are given access to any physician that participates in the Medicare coverage. This enables you to see thousands of health care providers located all over the country. Because it does not matter what insurance company is providing your Medigap plan coverage, you are free to see any physician that accepts Medicare. This access takes the hassle out of trying to find a doctor that will accept your supplemental coverage. Over 90% of all primary care doctors in this country accept Medicare, giving you unprecedented access to the health care that you prefer. The simplicity of use for Medigap coverage makes it easier to understand than Medicare Health Advantage Plans.
Medicare has an official enrollment period time of seven months. During this initial enrollment period (IEP), insurance companies cannot deny coverage nor can they charge customers more for preexisting conditions. After this seven-month IEP, those stipulations of guaranteed coverage go away. If you do not purchase your preferred Medigap plan during this IEP, you run the risk of being turned down based on your current health. Or the insurer may accept you for the Medigap plan but then decide to set higher prices for your specific policy due to a preexisting condition. For this reason, it is important to purchase your Medigap plan when you first enroll in Medicare. Delaying the enrollment could cost you a significant amount of money should your health deteriorate down the road.
Exclusions to Consider
There are three states that standardize Medigap Plans according to different rules. If you live in Massachusettes, Minnesota, or Wisconsin, you will want to check with the specific standards of your state before deciding on a plan.
It is also important to remember that Medigap policies do not cover long-term care, dental care, vision benefits such as appointments and eyeglasses, hearing aids, or private nursing. Most of the Medigap plans also do not cover prescription drugs. Be sure to factor these costs into your overall health insurance costs.
It is not uncommon for all of this information and data to leave your head spinning. Fortunately, there is an abundance of resources available to help you to compare plans. In addition to the official Medicare comparison charts, you can also consult the assistance of an insurance advisor. The most important components to completely understand when comparing options are the total costs, health care provider networks, coverage levels, and maximum out-of-pocket expenses for each type of plan.
Before you decide on the best Medicap coverage for your needs, it is important that you shop around to compare rates. While it can be tempting, try not to compare your policy choices to those around you. There is no one-size-fits-all policy when it comes to Medicare supplemental plan options. You are the architect of your health insurance plans, making it important that you clearly understand the benefits that you are getting for your money. With the right research and execution, you can help to ensure that you are not left without the coverage that you need.