What’s the Difference Between a Medigap Plan and a Medicare Advantage Plan?

June 13, 2023

What’s the difference between a Medigap plan and a Medicare Advantage plan?

Medigap plans (referred to as Medicare Supplement plans) are generally PPO plans and you can see any doctor or hospital that accepts Medicare. Medigap plans all have an extra premium cost in addition to what a person pays for Medicare Part B. With Medigap plans you also need to purchase a separate Part D Prescription Drug plan.

Medicare Advantage plans are generally HMO plans that usually have no monthly premium cost and the Prescription Drug plan is included at no cost as well. A Medicare Advantage plan disenrolls you from Medicare and the insurance carrier you sign up for takes over 100% of your medical care.

Do I need Medigap if I have Medicare Advantage?

No, a Medicare-eligible person has to choose between a Medigap plan and a Medicare Advantage plan, they cannot have both.

At what age am I eligible for Medigap?

On the first of your birthday month when you turn 65. You must first apply for Medicare Parts A & B.

I thought I was covered by Medicare already; do I need either of these?

Medicare only covers you for 80% of your medical bills when you turn 65 as long as you have signed up for Medicare, it’s not an automatic enrollment. A Medigap plan pays the other 20% Medicare does not cover and the insurance carrier of a Medicare Advantage plan pays 100% of a person’s medical expenses.

When must I enroll for Medigap?

Before you enroll in a Medigap or Medicare Advantage plan you must first enroll in Medicare. You can enroll for Medicare Parts A & B 3 months before your 65th birthday month.

When must I enroll for Medicare Advantage?

At the same time you enroll in Medicare.

Which plan is cheaper?

Almost all Medicare Advantage plans have a zero monthly premium. Medigap plans start between $150 to $170 per month at age 65 and go up in price each year.

Can I switch from Medicare Advantage to Medigap?

Yes - at any time unless you have a serious pre-existing condition. However, you can only switch from a Medigap plan once per year during open enrollment which is from October 15th to December 7th.

Can I enroll in Medigap if I have a pre-existing condition? Yes - but only when you are first eligible at age 65. Blue Shield occasionally offers a special program called an “underwriting holiday” where a person can enroll even if they have pre-existing conditions.

Can I use any doctor with Medigap?

Any doctor that accepts Medicare, anywhere in the U.S.

Does Medigap cover prescription drugs?

No you need to purchase a separate Part D Prescription Drug plan when you are first eligible for Medicare or suffer a lifetime penalty if you sign up later.

Do I need to renew my Medigap policy every year?

No, both Medi-gap and Medicare Advantage plans roll over automatically each year.

Note: If you stay in an employer-sponsored medical plan you do not need to enroll in Medicare Part B only Medicare Part A. Three months before you leave your employer you should enroll in Part B and then sign up for a Medigap or Medicare Advantage plan effective the first of the month following the termination of your employer-sponsored medical coverage.

If you have any questions, please call Brad Purcha at (714) 991-4855.

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