Medigap vs. Medicare Advantage Plan

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A. There are very big differences between these two types of insurance, although both are options for people with Medicare. Technically, only medigap counts as "Medicare supplemental insurance" — in fact, that’s its formal name — but Medicare Advantage plans may provide some extra benefits that could be considered as supplementing Medicare.

Medigap & Medicare Advantage Plans

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What’s Medicare Supplement Insurance (Medigap)?

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

Medicare Advantage vs. Medicare Supplement

Medigap plans cover out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. Some plans may help pay for other benefits Original Medicare doesn’t cover, such as emergency health coverage outside of the country or the first three pints of blood. Medigap plans don’t include prescription drug benefits. If you don’t already have creditable prescription drug coverage (coverage that is at least as good as the Part D benefit), you’ll need to buy a separate stand-alone Medicare Part D Prescription Drug Plan to cover the costs of your medications. Also, Medicare Supplement plans generally don’t offer extra benefits like routine dental, vision, or hearing coverage beyond what’s already covered by Medicare.

What Is Medigap vs Medicare Advantage?

Medigap works along side your original Medicare helping to pay Medicare covered expenses that are not paid for by Medicare due to deductibles and coinsurance.  You will pay a premium for a Medigap plan but your out of pocket exposure in the event of a large claim will be less than with a Medicare Advantage plan Medicare Advantage takes the place of Medicare.  While you are still in the Medicare system and protections, responsibility for benefits and claim management are provided by the insurance company, not Medicare. You cannot have both a Medigap and a Medicare Advantage Plan since Medicare Advantage has different deductibles and copay’s than Medicare.  Premiums are much less than Medigap plans but you will have more out of pocket exposure in most cases.

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