- Medicare Advantage and Medigap are both sold by private insurance companies.
- They provide Medicare benefits in addition to what original Medicare covers.
- You may not be enrolled in both Medicare Advantage and Medigap, but you may switch between these plans during certain enrollment periods.
If you currently have Medicare Advantage, you can switch to Medigap during specific enrollment windows. Medicare Advantage and Medigap are examples of different insurance types you can have — just not at the same time.
If you want to switch from Medicare Advantage to Medigap, here’s what you need to know to make it happen.
Medicare Advantage and Medigap are both Medicare insurance plans offered by private insurance companies; however, they provide different types of coverage.
Medicare Advantage (Part C) replaces original Medicare (parts A and B) coverage, while Medigap (Medicare supplement) provides benefits that cover out-of-pocket healthcare costs like copays, coinsurance, and deductibles.
You can only be enrolled in either Medicare Advantage or Medigap – not both, so understanding the differences in these two Medicare programs is especially important when shopping for your Medicare coverage.
Also known as Medicare Part C, Medicare Advantage plans provide combined coverage in place of original Medicare – Medicare Part A (hospital or inpatient stay coverage), and Medicare Part B (medical services and supplies coverage) coverage. Medicare Advantage plans may also include Medicare Part D prescription drug coverage as well as extra coverage for things like dental, vision, hearing, and more.
Some people find bundling services into one monthly payment is easier to understand and often more cost-effective, and many people enjoy the extra services some Medicare Advantage plans offer.
Depending on the company and plan you choose, many Medicare Advantage plans limit the healthcare providers you may access to only those within their network. Medicare Advantage may become more complex than original Medicare if an individual with a Medicare Advantage plan needs to see medical specialists.
Advantages of a Medicare Advantage Plan
- Medicare Advantage Plans may cover some services traditional Medicare doesn’t, such as vision, dental, or wellness programs.
- These plans may offer packages that are tailored to people with certain chronic medical conditions who need particular services.
- These plans include prescription drug coverage.
- Medicare Advantage Plans can be less costly if a person only needs to see the list of approved medical providers on a Medicare Advantage plan.
Disadvantages of a Medicare Advantage Plan
- Some plans may limit doctors you can see, which could result in out-of-pocket expenses if you see a doctor who isn’t in-network.
- Some people who are very sick may find Medicare Advantage is very expensive due to out-of-pocket costs and needing to see providers who aren’t eligible under a certain plan.
- Some plans may not be available based on a person’s geographic location.
You can join Medicare Advantage after age 65 and after you’ve enrolled in Medicare Part A and B. If you have end-stage renal disease (ESRD), you can usually only join a special Medicare Advantage plan called a Special Needs Plan (SNP).
Medigap plans are sold by private insurance companies, and unless you purchase your Medigap plan before January 1, 2006, they do not cover prescription drugs. If you choose Medigap, you need to enroll in a Medicare Part D plan to have prescription drug coverage.
A Medigap policy is a supplement to your Medicare Part A and Part B benefits. You’ll still pay your Medicare Part B premium in addition to your a Medigap premium.
Advantages of a Medigap plan
- Medigap plans are standardized, which means if you move, you can still keep your coverage. You don’t have to find a new plan like you usually do with Medicare Advantage.
- The plans can help supplement healthcare costs that Medicare doesn’t pay, which reduces a person’s healthcare financial burden.
- While Medigap plans can often cost more on the front end than Medicare Advantage plans, if a person becomes very ill, they can usually reduce costs.
- Medigap plans are usually accepted at all facilities that take Medicare, making them less restrictive than Medicare Advantage plans.
Disadvantages of a Medigap plan
- Medigap plans require paying an additional insurance premium, which may be confusing for some people.
- The monthly premium is usually higher than Medicare Advantage.
- Plan F, one of the most popular Medigap plans, covers most out-of-pocket expenses. It’s going away in 2020 for new Medicare recipients. This may affect the popularity of Medigap plans.
Medigap policies are standardized by Medicare. This means you can choose from several policies that are essentially the same across the country. However, insurance companies can charge different prices for Medigap policies. This is why it pays to compare options when shopping for Medigap. Medicare supplement plans use letters as names. The 10 currently available plans include: A, B, C, D, F, G, K, L, M, and N.
Unless you purchased your Medigap plan before 2020, you’ll need Medicare Part D as well if you want prescription drug coverage.
Some states require insurance companies to sell at least one type of Medigap policy to those under age 65 who qualify for Medicare. Other states may not have Medigap plans available to those under age 65 who have Medicare.
You can buy a Medigap policy during the 6-month open enrollment period that occurs after you’ve turned age 65 and have enrolled in Medicare Part B. If you don’t enroll in this time, insurance companies may increase the monthly premiums.
You can only switch from Medicare Advantage to Medigap during key times of the year. Also, in order to enroll in Medigap, you must reenroll in original Medicare.
Times when you may switch from Medicare Advantage to Medigap include:
- Medicare Advantage open enrollment period (January 1–March 31). This is an annual event during which, if you are enrolled in Medicare Advantage, you may change Medicare Advantage plans or leave a Medicare Advantage plan, return to original Medicare, and apply for a Medigap plan.
- Open enrollment period (October 15–December 7). Sometimes called the Annual enrollment period (AEP), you may enroll in any Medicare plan, and you may switch from Medicare Advantage back to original Medicare and apply for a Medigap plan during this period.
- Special enrollment period. You may be able to leave your Advantage plan if you’re moving and your Medicare Advantage plan is not offered in your new zip code.
- Medicare Advantage trial period. The first 12 months after enrolling in Medicare Advantage is known as the Medicare Advantage trial period, if this is your first time having an Advantage plan, you may switch back to original Medicare and apply for Medigap.
- Use sites like Medicare.gov to compare the pricing of plans.
- Call your state’s insurance department to find out if a plan you’re considering has had complaints against it.
- Talk to your friends who have Medicare Advantage or Medigap and find out what they like and dislike.
- Contact your preferred medical providers to find out if they take a Medicare Advantage plan you’re evaluating.
- Evaluate your budget to determine how much you can reasonably expect to pay on a monthly basis.
- Medicare Advantage and Medigap plans are parts of Medicare that can potentially make health coverage less expensive.
- While choosing one or the other typically requires some research and timing, each has the potential to save you money in healthcare costs should the need arise.
- If you aren’t sure where to start, call 1-800-MEDICARE and a Medicare representatives can help you find the resources you need.