Medicare vs Medigap Comparison Chart

Medicare Advantage vs. Medicare Supplement (Medigap)

  • Original Medicare provides good basic health coverage, but Part B only pays 80% of approved costs in most cases, and some items are not covered such as prescription drugs.
  • Medigap supplemental insurance plans are designed to fill Medicare Part A and Part B coverage gaps.
  • Avoid penalties and gaps in coverage – most people should sign up for Medicare Part A and Part B within the seven-month window that starts 3 months before their 65th birthday.
  • Medicare Advantage plans, offered by private, Medicare-approved insurers, are an alternative to Original Medicare (Parts A and B) that also include additional coverages to fill gaps.
  • Medicare Part D prescription drug coverage is optional. If you don’t have qualifying drug coverage there may be financial penalties if you need to buy a policy later on.

Medicare Supplement Insurance, or Medigap plans, are not connected with or endorsed by the U.S. government or the federal Medicare program.

You Can Not Have Both, So Choose Wisely

Medicare Advantage and Medicare Supplement (Medigap) plans are different types of Medicare coverage.

You cannot have both at the same time. Medigap plans are supplemental insurance and helps to fill gaps by paying out-of-pocket costs associated with Original Medicare. 

Medicare Advantage plans replaces Original Medicare and generally provide additional benefits.

Both Medicare and Medigap have their own pros and cons, so it’s important to understand the differences. Which is better?

3 Key Differences

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COSTS

Medicare: Offers lower premiums but has copays

VS.

Medigap: The premiums are higher but offers little to NO copays

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REFERRALS

Medicare: You may be required to get a referral to see a specialist

VS.

Medigap: No referrals are necessary

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NETWORK

Medicare: You may be required to use in-network doctors and hospitals

VS.

Medigap: See any doctor nationwide that accepts Medicare

When is the Open Enrollment Period?

Your Medicare Supplement Open Enrollment Period begins the first day of the month your Medicare Part B becomes effective.

This six-month enrollment period grants you guaranteed issue rights for any Medigap plan available to you.

However, many carriers allow you to enroll in a Medicare Supplement plan up to six months before your Medicare Part B start date.

In most cases, when you switch from Medicare Advantage to Original Medicare, you lose your “guaranteed-issue” rights for Medigap. You generally have guaranteed-issue rights for 6 months when you’re 65 or older and enrolled in Medicare Part B. Without guaranteed-issue rights, insurance companies may require medical underwriting before selling you a plan.

Questions to Consider

    1. Can I choose my own doctor and hospital?
    2. Is there a network?
    3. Am I required to get a referral?
    4. Do I pay a monthly premium?
    5. What are my out-of-pocket costs?
    6. Is drug coverage included?
    7. Is dental, vision or hearing included?
    8. When can I enroll?

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