Choosing Between Medicare Advantage and Medicare Supplement Medigap Plan G

As Americans become eligible for Medicare, one of the biggest decisions they face is whether to stick with traditional Original Medicare combined with a Medigap Plan or enroll in a Medicare Advantage Plan. With over 26 million seniors opting for Medicare Advantage Plans in 2022, understanding the key differences between these two pathways can ensure you choose the best approach.

Original Medicare Parts A and B

Original Medicare consists of Part A, which provides hospital coverage, and Part B, which covers doctor visits and outpatient services. Medicare pays directly for services rendered by providers who accept Medicare nationwide. However, Original Medicare does not cover all costs, leaving gaps that beneficiaries must pay out of pocket.

Medicare Supplement or Medigap Plan G

Medigap Plans offered by private insurers provide supplemental coverage to fill gaps in Original Medicare. They help pay for Medicare deductibles, copayments, and coinsurance amounts that would otherwise come directly out of your pocket. Having a Medigap policy reduces unexpected medical costs not fully covered by Medicare Parts A and B.

Medicare Part D Prescription Drug Plans

In addition to a Medigap policy, most enrollees purchase a standalone Part D prescription drug plan offered by private insurers to add coverage for medications. Medigap Plans do not include prescription drug benefits. This requires enrolling in a separate Part D Plan.

Medicare Advantage All-in-One Plans

Medicare Advantage Plans combine all the coverage provided by Medicare Parts A, B and usually D into a single plan offered by private insurers. They provide an alternate way to get Medicare benefits compared to Original Medicare plus a Medigap Plan and separate Part D Plan. Many Medicare Advantage Plans also offer extra benefits not included in basic Medicare.

Pros of Original Medicare Plan Plus Medigap

Freedom to choose any doctor – You can see any provider nationwide that accepts Medicare payments. Medigap Plans have no networks.

Works well if you travel – Original Medicare covers you anywhere in the U.S. versus most Advantage Plans that limit you to a local service area.

Peace of mind – Medicare Supplement insurance covers cost-sharing amounts and caps your out-of-pocket liability providing financial protection from high medical bills.

Guaranteed renewable – Medicare cannot cancel your Medigap policy as long as you continue paying premiums.

May cost less if you’re healthy – For people who don’t use many medical services, Original Medicare with a Medigap Plan may provide lower overall costs.

Pros of Medicare Advantage Plans

Combines everything in one plan – Medicare Advantage bundles all doctors, hospitals, and prescription drugs together, requiring less shopping effort.

Often includes extra benefits – Many Advantage Plans offer dental, vision, hearing, fitness benefits and more not covered by Original Medicare.

May offer lower premiums – Medicare Advantage Plans can provide lower premium costs, especially regional Preferred Provider Organization (PPO) plans.

Provides annual out-of-pocket cap – Once you hit the plan’s maximum cost-sharing limit, additional covered services are paid at 100% for the rest of the year.

Encourages preventive care – Most Medicare Advantage Plans eliminate cost-sharing for many preventive services to motivate members to stay healthy.

Key Considerations in Making Your Choice

Costs – Compare premiums plus all out-of-pocket costs like copays and deductibles between plan options. Actual spending can differ greatly.

Provider choice – Make sure doctors you want to keep are in-network and understand referral rules. Medigap allows access to any Medicare provider.

Prescription drugs – Confirm medications you take are covered by each plan’s formulary. Copays also differ.

Travel needs – Original Medicare plus Medigap provides seamless coverage anywhere in the U.S. Most Medicare Advantage Plans limit you to a local service area.

Overall health – Your health conditions and frequency using healthcare services should guide whether Medigap or Medicare Advantage makes most financial sense long-term.

Supplemental benefits – Consider dental, vision, hearing coverage and fitness programs some Medicare Advantage Plans offer that aren’t part of basic Medicare.

Convenience – All-in-one Medicare Advantage Plans require less shopping across multiple plans but networks are limited.

Enrollment Periods and Changing Plans

Initial Enrollment Period – When first eligible for Medicare, you have a 7-month window to select plans. Your initial choice lasts at least a year.

Annual Enrollment Period – You can change your plan selections each fall during AEP from October 15 to December 7. New coverage takes effect January 1.

Medigap Open Enrollment – For 6 months when you’re first enrolled in Medicare Part B, Medigap Plans must cover you without medical underwriting.

Special Enrollment Periods – Qualifying events like moving allow you to change plans outside standard enrollment windows.

While you generally must stick with your Medicare Advantage and Medigap Plan for the entire year once enrolled, understand the windows to make changes to have proper coverage in place.

Why Compare Your Medicare Options Carefully

Selecting between traditional Medicare plus a Medigap Plan and prescription drug coverage versus a Medicare Advantage Plan is an important choice. Make sure you understand these key Medicare pathways and weigh the pros and cons of each. Comparing costs, coverage, flexibility, benefits, and convenience will ensure you choose the option that best aligns with your healthcare priorities and lifestyle needs. Speaking with an independent Medicare advisor can provide guidance to navigate Medicare Plan options before making decisions.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare Questions. Give Green Insurance Agency a Call at 904-717-1176. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.

FAQs

What is the difference between Medicare Advantage and Medicare Supplement Medigap Plan G?

Medicare Advantage (Part C) plans are offered by private insurance companies as an alternative way to receive Medicare benefits, while Medicare Supplement Medigap Plan G is a supplemental insurance plan that helps cover the costs that Original Medicare (Part A and Part B) doesn’t cover.

How does Medicare coverage work?

Medicare coverage includes Part A (hospital insurance) and Part B (medical insurance). Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part B helps cover certain doctor’s services, outpatient care, medical supplies, and preventive services.

What is the difference between Medicare Advantage and Medicare Supplement Plan?

The main difference is that Medicare Advantage Plans provide Medicare benefits through a private insurer, while Medicare Supplement Plans work alongside Original Medicare to help cover out-of-pocket costs.

How do I choose between Medicare Advantage and Medicare Supplement Plan?

When choosing between the two, consider your healthcare needs, budget, preferred doctors and healthcare providers, prescription drug coverage, and any additional benefits offered by the plans.

What is prescription drug coverage in Medicare Advantage and Medicare Supplement Plans?

Medicare Advantage Plans may include prescription drug coverage, while Medicare Supplement Plans require a separate prescription drug plan (Part D) if you want this coverage.

How do I choose the best Medicare Plan for me?

To choose the best Medicare Plan, evaluate your healthcare needs, medication requirements, preferred doctors and specialists, budget, and any additional benefits like dental and vision coverage offered by the plans.

Can I buy a Medigap policy if I have a Medicare Advantage Plan?

No, you cannot have both a Medicare Advantage Plan and a Medigap policy at the same time.

What is the best alternative to Original Medicare?

Medicare Advantage Plans are considered an alternative to Original Medicare, as they offer the same coverage as Part A and Part B, and often include additional benefits like prescription drug coverage and routine vision or dental care.

What does Medicare Part D prescription drug coverage include?

Medicare Part D provides prescription drug coverage and is offered by private insurance companies approved by Medicare. Part D Plans help cover the cost of prescription medications.

How do I return to Original Medicare from a Medicare Advantage Plan?

If you want to return to Original Medicare, you can disenroll from your Medicare Advantage Plan during certain times of the year and enroll in a stand-alone Part D prescription drug plan if needed, or a Medicare Supplement Medigap Plan.