Medigap Vs. Medicare Advantage - Which One Is Better?

Which one is a better option? It all depends on your needs,

14:59 19 February 2020

Having the ability to seek a doctor whenever you need to, is crucial in keeping your health in good condition, but the financial aspect of the equation usually hinders this process. That’s why almost everyone enrolls in a health plan, with Medicare being the seniors’ favorite. Medicare has made healthcare for seniors a much more affordable deal; all they have to do is to enroll in the plan, pay a premium, and get health coverage. As appealing as it sounds, the Original Medicare plan has many flaws and loopholes, which gave rise to Medicare Advantage and Medicare Supplemental Plans: Medigap. But which one is a better option? It all depends on your needs.

Original Medicare Health Plan

Medicare has four parts. These parts cover different aspects of health care as follows:

1. Part A covers inpatient or hospital care
   
   
2. Part B includes outpatient care, such as doctor visits, procedures, equipment, etc.
   
   
3. Part C is a Medicare Advantage (we’ll get to it in a minute)
   
   
4. Part D covers drug prescription.
   
   

The Original Medicare plan only covers parts A and B, but not fully. You’ll be required to make a lot of out-of-pocket expenses in the form of deductibles, co-payments, and co-insurance. These expenses will quickly become overwhelming, which is why considering Medigap or Medicare Advantage plans can be quite cost-efficient.

Medigap Plans

Medigap is a Medicare supplemental plan; it doesn’t take its place, it only serves in covering the gap in costs of the Original Medicare. You can only enroll in a Medigap plan if you have an active Medicare plan. While all Medigap plans serve in reducing out-of-pocket expenses, some offer more coverage than others. Most plans will cover -- fully or partially -- Part A, blood pints, foreign travel, and skilled nursing costs. Part B deductibles are only covered by Plans C and F, and additional Part B charges are only covered by Plans F and G. One thing you can always rely on in Medigap plans, though, it’s that all plans are standardized, no matter the provider or the location.

 

There were 10 different Medigap plans to choose from, but, as of 2020, the case has become a little bit different. Some plans were stopped, but they’re available to only those who have previously enrolled in those plans before 2020. Anyone enrolling in Medigap after 2020 can no longer enroll in these plans. For instance,

Plan F, as explained on https://medicarewire.com/medigap/medicare-supplement-plans/medicare-plan-f/, was one of the most popular Medigap plans, but not all can apply for this plan; only those people who turned age 65 prior to January 2020 are eligible. This plan offers complete coverage of all out-of-pocket expenses, including Part B deductibles and copayments. Today, Plan G has risen to be the most cost-effective and favored plan instead of plan F.

Medicare Advantage Plans

Once you enroll in a Medicare Advantage plan, you give up Original Medicare. In return, you get to have one card to manage all your health plan benefits, instead of the multiple cards and documents you’ll have to go through for an Original Medicare plus Medigap plans. That’s because you’ll have one provider covering all of your insurance.

Medicare Advantage has some advantages over both the Original Medicare and Medigap in the benefits it provides, as some of these benefits include partial drug prescription coverage and dental and vision care. You may even get a gym subscription on this plan. The premium you’ll pay to enroll in this plan is also lower than that of Medicare and Medigap combined, which can be more cost-effective for you.

On the other hand, you’ll be limited to a network of physicians who accept Medicare Advantage, which is narrower than the options you’ll have with Medicare. You’ll also have to be careful with your healthcare needs, as this plan comes with a cap, for the insurance it provides. You can quickly find yourself overwhelmed with out-of-pocket expenses once you reach this cap. The plan also changes annually in its premiums and caps, so you’ll need to be alert to any changes that could affect you. Finally, there’s a limited window of enrollment, which starts October 15 and ends December 7 every year. Missing this window means you’ll have to be stuck with your current plan for another year.

At the first glance, Medicare Advantage can seem to be a better option for you. The plan offers additional benefits and the premium is lower than enrolling in a Medigap plan. However, it all comes back to your healthcare needs. If your healthcare needs are extensive, you’ll be better off with a Medigap plan that can provide sufficient coverage. Otherwise, a Medicare Advantage can serve you well if all you need is regular checkups and occasional doctor visits.