Choosing health insurance is a crucial decision for your health and future. Fortunately, when it comes to choosing Medicare, you’ve got options.
Medicare Advantage (Part C) and Medicare Supplement (Medigap) are additional plans that pair with your Original Medicare (parts A and B). They may offer you the customization you need to meet your individual healthcare needs.
Both plans are designed to offer coverage that other parts of Medicare may not. However, you may not purchase both Medicare Advantage and Medigap.
If you want additional Medicare coverage, you must choose either Medicare Advantage or Medigap.
If that sounds a little confusing, don’t worry. We’ll explain more below.
Medicare Advantage plans are private insurance options for Medicare coverage. These plans cover what Original Medicare does, including:
- prescription drugs
Depending on which Advantage Plan you choose, your plan may also cover:
Medicare.gov has a tool to help you find a Medicare Advantage Plan that meets your needs.
Medicare Supplement, or Medigap, is a different set of plans that help cover out-of-pocket costs and things not otherwise covered in your Original Medicare plan, like copayments and coinsurance.
As of Jan. 1, 2020, newly purchased Medigap plans don’t cover Part B deductibles. You can purchase Medigap in addition to your other Original Medicare coverage (parts A, B, or D).
Medicare.gov has a tool to help you find a Medigap plan that meets your needs.
To help you compare, here are both plans side by side:
|Medicare Advantage |
|Medicare Supplement coverage (Medigap)|
|Costs||Varies by plan provider||Varies by age and plan provider|
|Eligibility||Age 65 or older, enrolled in parts A and B||Age varies by state, enrolled in parts A and B|
|Specific coverage||Everything covered by parts A, B (sometimes D), and some additional benefits for hearing, vision, and dental; offerings vary by provider||Costs like copayments and coinsurance; doesn’t cover dental, vision, or hearing|
|Worldwide coverage||You must be within your plan’s coverage area||Plans for emergency coverage within 60 days of your international trip|
|Spousal coverage||Individuals must have their own policy||Individuals must have their own policy|
|When to purchase||During open enrollment, or your initial enrollment in parts A and B (3 months before and after 65th birthday)||During open enrollment, or your initial enrollment in parts A and B (3 months before and after 65th birthday)|
There are several requirements you must meet to be eligible for Medicare Advantage or Medigap plans. Here’s how to tell if you’re eligible for Medicare Advantage or Medicare Supplement:
- Eligibility for Medicare Advantage:
- You’re eligible for Part C if you’re enrolled in parts A and B.
- You’re eligible for Medicare Part A and B if you’re 65 or older, have disabilities, or have end stage renal disease.
- Eligibility for Medicare Supplement coverage:
- You’re eligible for Medigap if you’re enrolled in Medicare parts A and B.
- You’re not already enrolled in Medicare Advantage.
- You meet your state’s requirements for Medigap coverage.
You can purchase Medicare Advantage, or Medicare Part C, through an approved private provider as a part of your Medicare coverage. The costs of each plan are determined differently. Read on for an explanation of how the premiums and fees are determined.
Medicare Advantage cost
Much like any other insurance plan, Medicare advantage premiums vary across the board depending on the provider you choose to enroll with and the plan you choose.
Some plans don’t have a monthly premium; some charge several hundred dollars. But it’s unlikely you’ll pay more for your Part C than you do for Part B.
Additionally, costs like copays and deductibles will also vary by plan. Your best bet when determining potential costs for your Medicare Advantage plan is to carefully compare plans while you shop.
Use the Medicare.gov tool to help compare Medicare Advantage plans and costs.
Other factors that may affect the cost of Medicare Advantage plans include:
- which Advantage plan you choose
- how often you want access to medical services
- where you receive your medical care (in network or out of network)
- your income (this may be used to determine your premium, deductible, and copays amount)
- if you have financial assistance like Medicaid or disability
Medicare Advantage is a good fit for you if:
- You already have parts A, B, and D.
- You have an approved provider you already like, and you know they accept Medicare and Medicare Advantage plans.
- You want additional covered benefits, like hearing, vision, and dental.
- You’d rather manage one plan for all of your insurance needs.
Medicare Advantage isn’t a good fit for you if:
- You travel extensively or plan to while on Medicare. (You must live within your plan’s coverage area, except for emergencies.)
- You want to keep the same provider each year. (The requirements for approved providers change annually.)
- You want to keep the same rate. (Rates change annually.)
- You’re concerned about paying for extra coverage you won’t use.
Medicare Supplement cost
Again, each insurance plan varies in price based on your eligibility and the type of coverage you want.
With Medicare Supplement plans, the more coverage you want, the higher the cost. Additionally, the older you are when you enroll, the higher a premium you may have.
Use the Medicare.gov tool to help compare Medicare Supplement rates.
Factors that may affect the cost of your Medigap coverage include:
- your age (the older you are when you apply, the more you may pay)
- the plan you choose
- if you qualify for a discount (nonsmoker, female, paying electronically, etc.)
- your deductible (a higher deductible plan may cost less)
- when you purchased your plan (rules can change, and an older plan may cost less)
Medicare Supplement coverage may be a good fit for you if:
- You prefer to choose the amount of coverage for out-of-pocket expenses you’re purchasing.
- You need help covering out-of-pocket expenses.
- You already have the coverage you need for vision, dental, or hearing.
- You plan on traveling outside of the United States and want to be prepared.
Medicare Supplement coverage may not be a good fit for you if:
- You already have a Medicare Advantage plan. (It’s illegal for a company to sell you Medigap when you already have Medicare Advantage.)
- You want coverage for extended long-term or hospice care.
- You don’t use much healthcare and don’t usually meet your annual deductible.
Enrolling in Medicare can be confusing. If you’re helping a friend or family member enroll, there are a few things you can do to make the process easier.
Here are some tips for helping your loved one enroll in Medicare:
- Discuss what their healthcare and coverage needs are.
- Decide on an affordable and realistic budget for insurance.
- Prepare your information and your loved one’s information for Social Security. They may need to know who you are and your relationship to the person you’re helping enroll.
- Talk with your loved one about whether they’ll need additional coverage like Part C or Medigap.
While you can help your loved one evaluate plans and understand their choices, you may not enroll another person in Medicare unless you have a durable power of attorney for that individual. This is a legal document that gives you permission to make decisions on behalf of another person.
Medicare coverage comes in a variety of plans. It’s important to tailor your care to your specific needs.
Medicare Advantage covers your Part A, B, and often D plans and more. Medigap helps pay out-of-pocket costs like copays and coinsurance.
You can’t purchase both, so it’s important to know your needs and choose the option that best meets them.