Medigap or Medicare Advantage Plan
Medigap or Medicare Advantage Plan
Medigap Plans
Medigap plans work with Original Medicare to pay your Part A and Part B copays and deductibles. They do not cover your premiums for Part A and Part B, and also do not cover any prescription drug costs. Companies can only sell standardized Medigap policies, identified by letters A through N. With a Medigap plan, you can visit any doctor or facility that accepts Medicare. Monthly premiums for Medigap plans can vary significantly by company and plan. The New York State Department of Financial Services maintains a website with the current pricing on all medigap plans in New York State. In New York State it is important to know that you can enroll in or change your medigap plan at any time of the year.
Medicare Advantage Plans
Medicare Advantage plans typically provide all of your healthcare coverage. They are still part of the Medicare program but offered by private companies. You must still pay the Part B monthly premium. They are referred to as Part C. Some plans (HMO) require you to use their network of participating doctors and hospitals. Other plans (PPO) allow you to go outside the network to non-participating doctors, but that is usually more expensive. With Medicare Advantage plans, you still receive Part A and Part B services, but the actual benefits and costs may be different than Original Medicare. There are many plans with very low or actually no monthly premiums. You'll have to pay a copay for most services, but most plans also include your prescription drug coverage. It is important to note that all Medicare Advantage plans must cover valid emergency room treatment anywhere in the country. Also, many Medicare Advantage plans now offer extra benefits, such as vision, dental, hearing and transportation services.
Medigap or Medicare Advantage Plan?
Whether to choose a Medigap plan or a Medicare Advantage plan depends on your health, your lifestyle and your financial situation:
Medigap plans have higher monthly premiums, but small or no copays for medical services. Medicare Advantage plans have lower or no monthly premiums, but you will pay a copay for most services.
Individuals requiring expensive or many medical services (e.g., chemotherapy, radiation, some in-office injections) will often choose a Medigap plan. Whereas, individuals requiring less expensive medical services might choose a Medicare Advantage plan.
With a Medigap plan, you can visit any doctor or facility in the country that accepts Medicare. With Medicare Advantage plans, you usually visit the plan’s participating doctors or facilities but some plans will allow you to go out of their network.
With Medigap plans, you must buy a separate Part D prescription drug plan. However, Medicare Advantage plans usually include prescription drug coverage.
Medicare Advantage plans can offer additional services such as vision, dental and hearing not available through a Medigap plan.