Many seniors are surprised to learn that Medicare does not cover everything, even after paying into it our entire lives. Many seniors will have to resort to either a Medicare Advantage plan or buy a Medicare supplement (Medigap) policy at additional cost to cover the gaps in their health care coverage.
But which one is right for you?
In this article we are going to go over all of the pros and cons of both types of plans and which one is best for you.
Table Of Contents
Both Medicare Advantage and Medigap are designed to help cover the gaps in original Medicare that everyone is signed up for. However, they operate very differently.
Medicare Advantage plans are operated by a private insurance company. Government Medicare pays them and you get all of your benefits from the private insurer who then pays for medical care. While Medicare Advantage plans can be as low as $0 a month, you will have co-pays and coinsurance for some services with Medicare Advantage.
Medigap plans are private insurance plans that pay for any gaps that government original Medicare does not pay for. Medicare will pay their share, and then the private insurance company will cover the rest. While these plans monthly premiums are more than Medicare Advantage, you generally will not pay anything for your medical care the rest of your life, depending on the plan you get.
How do Medicare Advantage plans offer coverage basically for free? The reasons is because you can only use their network of doctors and specialists, and you have co-pays and coinsurance for some services. Your doctor that you use now might not be in the network, depending on the insurance company you go with.
Copays for Medicare Advantage vary from state to state and company to company, but most of the time you will not pay anything for primary care doctor visits, and a co-pay of $20-$50 for specialist visits.
Hospital visits under Medicare Advantage for the first week in the hospital can be over $250 a day, and most plans cover the rest of the visit after that.
Coinsurance costs vary depending on the procedure. For example, you might have to pay 20% coinsurance for chemo if you ever get cancer, which can be very expensive.
Out Of Pocket Maximum
To protect people on Medicare Advantage plans, you have a yearly out of pocket maximum. These again vary depending on the company and location, but these maximums are from $3000-$7,550, which is the maximum allowed under any plan.
Most Medicare Advantage plans come with drug coverage, so there is no need to purchase a Medicare Part D plan. However, just with doctors, Medicare Advantage plans don’t cover all prescription drugs. It is pretty simple to check if a plan does cover a prescription, just make sure that it does before you get into the plan. We can help you check this.
Medicare Supplements (Medigap)
Medicare Plan F, G, and N are the most popular supplement plans. Click here to read our guide on which supplement plan is best for you.
Many people purchase the most comprehensive Medigap plan so that they don’t have to worry about any co-pays or payments of any kind when they need routine medical care or have an emergency. Medigap plans generally cover almost every single piece of health care that original government Medicare does not cover. However, these come at far greater cost than Medicare Advantage in monthly premiums.
For example, the average cost for someone turning 65 and enrolling in a comprehensive Medigap plan is around $130 a month.
There are no co-pays or coinsurance, and consequently no out of pocket maximum, however.
One great thing about Medicare Supplement plans is that you can use any doctor or hospital that accepts Medicare, meaning you can keep your doctor and don’t have to worry about a provider being in network.
Medigap plans do not come with prescription drug coverage so you will need to purchase a Part D plan to go along with these.
Part D plans are around $10-$15 a month for most people.
You can also get a free prescription drug card from us to use instead, but keep in mind that you can not use both Part D and a prescription drug card. You must choose one or the other.
If you want a free prescription drug card just fill out our quote form or chat with a live agent and we will send it to you.
Pros & Cons
Deciding which type of healthcare coverage is best fo you is a very important decision, especially if you live off of social security alone.
No one knows the future, but it can really be boiled down to this…
If you rarely need any serious health care, are in good health and your doctor is in network, Medicare Advantage is better for you.
If you require often healthcare treatment, have expensive prescriptions, or want to stay with your doctor who is not in network with any insurance companies, Medigap is for you.
With that being said, you should plan for a rainy day. If you are in good health and choose Medicare Advantage, store some of that savings away in case you every do have to go to the hospital for a few days and have to pay those co-payments. You never know what’s going to happen in the future.
Choose The Right Plan
If you still are not sure or are ready to move forward with a Medigap or Advantage plan, we are here to help. We represent all of the top carriers in the business and can go over all of your options and find the best price out of all of the companies available to you.
We’ll be able to see if your doctor is in network, if the plan takes your prescription drugs if you have any, and give accurate quotes in just minutes.
Give us a call or fill out our quote form and we will be in touch with you ASAP to move this transition to Medicare as smooth as possible.
We look forward to speaking with you!