As a Medicare beneficiary, you have coverage options. For example, you can choose to sign up for a Medigap policy or a Medicare Advantage (Medicare Part C) plan. It's important for you to understand some of the differences between these options and the benefits they offer. The plans don't work with one another, so if you decide to sign up for Medicare Advantage, you cannot sign up for Medigap, and the opposite is also true.

 

What is Medigap?

 

Medigap, also known as Medicare Supplement or MedSup, is private health insurance. A Medigap policy can help pay for some of the costs that aren't covered by Original Medicare, Part A and Part B, including copayments, coinsurance, and deductibles. It may also cover the cost of health care while traveling outside the United States. Medigap is designed to fill the coverage gap in Original Medicare, with each plan (Original Medicare and Medigap) paying its share of a beneficiary's health care costs. As such, Medigap supplements but does not replace Original Medicare.

 

Medigap plans are guaranteed renewable; that is, the Medigap insurance company cannot drop coverage for you because of a health condition.

 

If you sign up for a Medigap policy, you still need to be enrolled in Original Medicare, Part A and Part B, and continue paying your Part B premium.

 

What is Medicare Advantage?

 

Like Medigap, Medicare Advantage is private health insurance. Unlike Medigap, Medicare Advantage plans must include all benefits available under Original Medicare, Part A and Part B.

 

While Medigap fills the coverage gap in Original Medicare, Medicare Advantage essentially replaces Original Medicare. Be aware that you must be enrolled in Medicare Part A and be eligible for Medicare Part B to enroll in a Medicare Advantage plan.

 

Choosing a Medigap Plan

 

There are 10 standardized Medigap plans available in 47 states, and they are all required to follow federal and state laws designed to protect beneficiaries. All plans have to be clearly labeled "Medicare Supplement Insurance," and insurance companies can only sell the 10 standardized policies, which are identified with one of the following letters: A, B, C, D, F, G, K, L,M, and N. All 10 Medigap plans offer the same basic benefits, but some of them have extra benefits, so you should review each policy carefully and select the one that best fits your health needs. Your costs will vary from one plan to another.

 

Since each insurance company is allowed to decide which Medigap plans it wants to sell, all 10 policies may not be available in your area of residence. In general, however, insurance companies have to offer Medigap Plan A if they want to sell any Medigap plan, plus Plan C or Plan F.

 

Medigap plans are standardized differently in Massachusetts, Minnesota, and Wisconsin. For more information about Medigap plans in the 50 states, see Medicare Supplement Plans by State.

 

Timing is important if you want to sign up for a Medigap policy. The best time to sign up is when you first qualify for Medicare. See When to Apply for a Medicare Supplement Plan for more information.

 

Choosing a Medicare Advantage Plan

 

There are many types of Medicare Advantage plans available, and beneficiaries can generally select one of the following plans:

• Health Maintenance Organization (HMO)

• Preferred Provider Organization (PPO)

• Private Fee-for-Service (PFFS)

• Medical Savings Account (MSA)

• Special Needs Plans (SNPs)

 

As opposed to the 10 Medigap plans, which are standardized, Medicare Advantage plans have varying rules (for example, some plans require you to choose a primary care physician who's in their network). Some Medicare Advantage plans offer additional benefits, such as routine vision, dental, or prescription drug coverage. Availability and costs of plans may differ by carrier and location. Medicare Advantage plans may require you to pay monthly premiums, annual deductibles, copayments, and coinsurance.

 

Comparing Medigap and Medicare Advantage

 

Here's a brief summary of the basic differences between Medigap and Medicare Advantage:

• Medicare Advantage plans replace Original Medicare, Part A and Part B, while Medigap plans add onto your Original Medicare coverage.

• Benefits and coverage under the 10 standardized Medigap plans are the same in the 47 states that offer them. Medicare Advantage plans offer coverage that varies according to each plan or organization and location.

• Most Medicare Advantage plans include prescription drug coverage. Medigap doesn't offer drug coverage, so you'll have to enroll in a separate prescription drug plan if you need this coverage.

• Remember that if you are enrolled in a Medicare Advantage plan, you cannot enroll in a Medigap plan. The two plans don't work together.

 

To decide which option best suits your individual health needs, you might start by researching the various Medigap and Medicare Advantage plans available in your area, and learning exactly what each of them offers and what costs you could expect. eHealth Insurance offers Medigap plan quotes as well as Medicare Advantage plan quotes to help you receive health coverage if you use the plan finder button on this page. You can also compare plans at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227) (TTY users 1-877-486-2048), 24 hours a day, seven days a week.

 

Do you have more questions? Connect with any of our Licensed Insurance Agents to answer your Medicare questions or discuss a Medicare plan that is right for you.
Make an appointment to talk to a Licensed Insurance Medicare Agent.