People might have a difficult time deciding whether to enroll in a Medicare Advantage plan (Medicare Part C) or a Medicare Supplement plan (also known as Medigap).
With a Medicare Advantage plan, the beneficiary receives all of their services through the plan rather than from the federal Medicare program. These plans must provide at least the same amount of coverage as Original Medicare, Part A and Part B, but some may have additional benefits.
With a Medicare Supplement plan, Medicare benefits are provided by Original Medicare, Part A and Part B, and the Medigap plan covers the beneficiary’s share of the out-of-pocket costs associated with Original Medicare benefits.
Both types of plans have their own specific advantages and disadvantages. It’s worth noting that you cannot enroll in both. Medicare Advantage plans do not work with Medicare Supplement plans. This means that you cannot use your Medigap plan to take care of the copayments, premiums, or deductible from your Medicare Advantage plan.
The benefits of a Medicare Advantage plan may include the following, though may not always be the case as plan details and pricing can vary by provider.
- Potentially low monthly premiums
- Drug coverage included with most Medicare Advantage plans, known as a Medicare Advantage Prescription Drug plan or MA-PD
- Possible ancillary benefits, such as routine dental, routine vision, and health club membership
- Managed care, such as supervision of doctors by the plan, possible case management, sometimes a 24-hour nurse hotline
- Availability to all individuals entitled to Medicare Part A and enrolled in Medicare Part B who reside within the service area, without regard to age or health conditions, except for end-stage renal disease
Disadvantages include:
- Cost sharing and copayment structure for services
- Network restrictions
- Possible geographic area restrictions
- Possible requirement of referrals
The benefits of a Medicare Supplement plan can be:
- Freedom to see any provider that accepts Original Medicare, Part A and Part B
- Minimal to no cost sharing for Medicare-covered services, depending on the plan
- Freedom to use the plan nationwide (except for Medicare SELECT plans)
- No medical underwriting if the plan is purchased during the Medigap Open Enrollment Period, which lasts six months beginning the month a beneficiary turns 65 and is enrolled in Medicare Part B
Disadvantages include:
- Potentially high monthly premiums
- Drug coverage not included but can be added separately through a Medicare Part D plan
- Medical underwriting, except during the Medigap Open Enrollment Period, unless beneficiary qualifies for guaranteed issue rights due to special circumstances
- Depending on the state, plan choices may be limited and more expensive for individuals under 65
Please note that these are general considerations, which can be affected significantly by various factors, including state laws and the availability and cost of plans in specific areas.
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