Medicare Advantage vs. Medigap

Medicare Supplements

Simply put, with Medicare Supplements you receive benefits from Medicare and the supplement pays for some of the gaps. With Medicare Advantage you are receiving benefits from that insurance company not Medicare. These two Medicare parts are designed to serve different purposes and both have pros and cons. In this guide, we’ll explain the two plans in order to help you know the differences and how they function

Washington Medicare Supplement plans are sold by Medicare-approved insurers. Medicare is still your primary insurance when you are enrolled in a gap plan. When you go to the doctor you can see any doctor in the nation who takes Medicare. You will show your Medicare card and your Medigap card at your office visit.

There are no referrals to see specialists. You are able to see over 600,000 Medicare Providers nationwide. You have the flexibility to travel and see providers in other states and areas as health and life needs change.

Part D Drug Plan and Medigap

When you have a Medigap plan in WA if you want RX coverage you will need to purchase a separate Part D plan. These plans can be very affordable. If you don’t enroll in a Part D plan and you do not have creditable coverage you can get a late enrollment penalty if you enroll in a Part D plan at a later date.

Higher Premiums 

Typically, Medigap plans have higher premiums compared to Part C Medicare Advantage Plans. Knowing that you might ask why would someone enroll in a plan that costs more? The premiums cost more, but if you enroll in a Plan G or a Plan F you will have to pay very little when you go to your providers. The cost of Medigap plans in Washington varies based on the type of coverage you want, and the insurer. However, all Medicare Supplement plans provide the same coverage everywhere as they are standardized.

To enroll in Medicare Supplements, you must be enrolled in Original Medicare. There is an enrollment period for Medicare Supplement during which you have a guaranteed issue right as long as you are eligible. This means the insurer cannot use medical underwriting or charge you more based on pre-existing conditions. You can enroll during your Initial Enrollment period easily once you are eligible.

Switching plans

In Washington if you are enrolled in a plan B-N you can change to any other B-N plan at any time without underwriting. If you are enrolled in plan A you can switch to another plan A without underwriting.

Medicare Advantage

Medicare Advantage plans also known as Part C are sold by private insurers Medicare Advantage combines Part A and Part B coverage, i.e. it covers the healthcare services under Medicare Part A and Part B, e.g. hospice care, durable medical equipment, doctor visits, skilled nursing facility care, ambulance rides, etc. Many Part C plans also include services that are not covered under Original Medicare, such as prescription drug coverage, dental, vision, hearing, fitness memberships, etc.

Part D and Medicare Advantage

You can enroll in a Medicare Advantage plan that includes Part D coverage. This is known as a MAPD. If your Medicare Advantage plan does not include Part D then it is simply known as MA. If you are enrolled in a MA or a MAPD you cannot also enroll in a separate Part D.

Many people look at the $0 premium Medicare Advantage plan and forget to make sure the plan covers their prescriptions. If you want drug coverage you will need to enroll in a MedAdvantage plan that includes drug coverage. Medicare Advantage plans do not cover every prescription drug. It is very important to look up your drugs on the plans formulary to verify they are covered under the plan.

MedAdvantage and Network

When you are enrolled in a MedAdvantage plan you no longer use your Medicare Card or go to providers who take Medicare. You will be using your Medicare Advantage network of providers and you will be receiving benefits from your plan instead of Medicare.

Low Premiums

MedAdvantage premiums are lower than Medigap plans. In Washington, 98% of Medicare beneficiaries have access to a $0 premium plan. Even though a plan has a $0 premium you will still pay your monthly Part B premium. With this savings, you will have a smaller network of providers to see compared to a Medicare Supplement. It is very important to verify the providers you use are in the network if you enroll in a MedAdvantage Plan.

Pay when you use

When you are enrolled in a Washington Medicare Advantage plan you will have to pay copays or coinsurance when you use providers or services. Plans do have an out of pocket maximum to limit your annual exposure. Plans have different out of pocket maximums so make sure you check that amount to make sure you can afford to pay it if you have a catastrophic health event.

Changing Plans 

In most situations you can only change Medicare Advantage plans during the fall AEP from October 15th – December 7th. There is a 12-month trial period for Medicare Advantage plans. If you do not like your Medicare Advantage plan you can dis-enroll in your first 12 months and go back to original Medicare and your Medigap plan without underwriting. You can also change MedAdvantage plans mid year if there is a Medicare 5 star rated plan in your area to enroll in.

How do you choose?

What worked for your friend might not be a good fit for you as everyone has different health and budget needs. Luckily there is no wrong choice. McGregor Benefits can help you review your options to see what Washington supplement or Medicare Part C Advantage plan fits your needs.