Most Americans have heard of Original Medicare as one of many healthcare coverage options, but they may not understand how it differs from Medicare Advantage and how Medicare Supplement Insurance (Medigap) fits into the mix. This article explains the differences in coverage between Medicare Advantage and Medigap policies. Further, while this article provides useful information about the differences between these healthcare options, each person should ultimately consult with their primary care provider to find what works best for their needs.

What Is Medigap?

A Medigap plan is a form of private, supplemental health care insurance that provides coverage for things one’s primary Original Medicare insurance does not.

Original Medicare vs. Medicare Advantage

To understand Medigap’s role, it is important first to understand the difference between Original Medicare and Medicare Advantage. Original Medicare consists of Part A and Part B coverage, which covers most general doctor and hospital visits. However, it doesn’t cover everything, so those with Original Medicare can opt for a supplemental Medigap plan to cover the excess. Alternatively, Medicare Advantage covers more than Original Medicare, so adding a Medigap plan is neither necessary nor allowed. Further, it is illegal for anyone to try to sell someone who has Medicare Advantage a Medigap policy unless they are switching to Original Medicare.

Considerations When Choosing a Plan

When deciding between Medicare Advantage and Original Medicare supplemented with a Medigap policy, there are several factors that should be accounted for. Consider the following:

  • Doctor and hospital choice—With Medicare Advantage, you will be limited to the doctors in your plan’s network and will likely need a referral or be charged higher fees to see someone out of network. With Original Medicare and a Medigap policy, you will likely be able to go anywhere that accepts Medicare, which is most places in the U.S.
  • Cost—Cost can vary, but generally, Medicare Advantage can save you money on premiums. However, if you need additional prescription drug coverage—Part D services—you should compare them to the prescription drug policies under Original Medicare to determine the option that is more cost-effective for you.
  • Lifestyle—Neither Original Medicare nor Medicare Advantage usually has foreign coverage; however, certain Medigap policies do. If you travel abroad frequently, this may be a better option. Similarly, if you frequently travel within the U.S., opting for Original Medicare and a Medigap plan may be a better choice because they are accepted by more providers than Medicare Advantage.
  • Health—Someone who needs more frequent care may be better off with an Original Medicare plan and Medigap policy, while a person that has fewer doctor’s visits may prefer Medicare Advantage. Each individual’s health concerns and conditions are going to determine how frequently they need to go to the doctor, and they should discuss these needs with their primary care physician prior to selecting a plan.

There are several components that go into selecting which healthcare plans and policies are right for someone. While Medicare Advantage and Medigap policies may seem similar, they have many important differences. After considering factors such as individual health, budget, and preferred providers, you will be in a better position to select a plan that works well for you.

If you have more questions about Medicare Advantage, Original Medicare, or Medigap policies, please contact Bates Hewett & Floyd Insurance.





This Know Your Benefits article is provided by Bates Hewett & Floyd Insurance Agency and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. © 2023 Zywave, Inc. All rights reserved.