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Medicare Supplement Insurance (Medigap) vs. Medicare Advantage

Christian Worstell

by Christian Worstell | Published April 26, 2021 | Reviewed by John Krahnert

Medicare Supplement Insurance (also called Medigap) are private plans sold by insurance companies to work alongside your Original Medicare coverage to help cover out-of-pocket costs.

Medicare Advantage plans (also called Medicare Part C) are also sold by private insurance companies, but they are used as an alternative your Original Medicare coverage. 

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5 Facts About Medicare Supplement Insurance

Original Medicare (Medicare Part A and Part B) provides insurance coverage for a number of health care costs.

Medicare Part A and Part B cover in-hospital care and doctors visits, treatment services, medical devices and supplies from Medicare approved providers.

If you want to get the most out of your coverage, Medigap insurance can help you with the out-of-pocket costs that come with Original Medicare, such as deductibles, copays and coinsurance.

1. Medigap is not Medicare Advantage.

Medigap plans supplement Original Medicare benefits and can be used to help pay some of your out-of-pocket costs that come from Medicare-approved health care.

  • Again, Medigap is another name for Medicare Supplement Insurance, so there is no difference between Medigap vs. Medicare Supplement Insurance plans.

  • Medicare Advantage plans are an alternative to Original Medicare. With a Medicare Advantage plan, you receive your Medicare benefits from your private health plan instead of through the government.

The insurance company providing the plan may provide additional benefits — such as prescription drug coverage, dental coverage and vision coverage — but will be required to at least provide the basic benefits that Original Medicare offers. Prices and additional benefits will vary by provider.

Unlike Original Medicare, coverage may be provided via a specific network of doctors and hospitals. Depending on the policy, out-of-network services may be more expensive or not covered at all.

You cannot have Medicare Advantage and Medigap at the same time. Medigap policies do not work with Medicare Advantage plans. 

2. There are 10 standardized Medigap options

You can compare the basic benefits of each type of Medigap plan to find the one that works for your situation.

Not every insurance company is required to offer each of the 10 standardized plans. However, the basic benefits for each Medigap plan are standardized by Medicare.

Compare the basic benefits of each type of Medigap plan below.

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Medicare Supplement Benefits

Part A coinsurance and hospital coverage

Part B coinsurance or copayment

Part A hospice care coinsurance or copayment

First 3 pints of blood

Skilled nursing facility coinsurance

Part A deductible

Part B deductible

Part B excess charges

Foreign travel emergency

Medicare Supplement Benefits A B C* D F1* G1 K2 L3 M N4
Part A coinsurance and hospital coverage
Part B coinsurance or copayment 50% 75%
Part A hospice care coinsurance or copayment 50% 75%
First 3 pints of blood 50% 75%
Skilled nursing facility coinsurance 50% 75%
Part A deductible 50% 75% 50%
Part B deductible
Part B excess charges
Foreign travel emergency 80% 80% 80% 80% 80% 80%

* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.

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1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,490 in 2022. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

2 Plan K has an out-of-pocket yearly limit of $6,620 in 2022. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

3 Plan L has an out-of-pocket yearly limit of $3,310 in 2022. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.

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3. Your open enrollment period is the best time to purchase a Medigap plan

During your Medigap open enrollment period, Medicare Supplement Insurance plans are offered without medical underwriting. That means insurers cannot deny you coverage or charge more for your Medigap plan based on your medical history or current conditions.

Your Medigap open enrollment period begins as soon as you are at least 65 years old and enrolled in Medicare Part B. This period only lasts for six months.

4. Medigap plans do not cover prescription drugs

Prescription drugs are covered under Medicare Part D but are not covered by Medicare Supplement Insurance plans.

At one time there were Medigap plans to supplement prescription drug costs, but they are no longer available. You can by a standalone Prescription Drug Plan to help pay for your medications.

You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

5. Medigap plans have the same benefits but not the same rates

Benefits for each type of Medigap plan are standardized — in other words, no matter where you purchase your plan, the coverage is exactly the same.

When you're deciding on a Medicare Supplement Insurance plan, work with a licensed agent who can help you find the right Medigap plan for your health care needs. 

Call today to speak with a licensed agent and learn more about your Medigap options.

 

Find Medigap plans in your area.

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Or call 1-800-995-4219 to speak with a licensed insurance agent.

 

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

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