What’s the Difference Between Medicare Advantage and Medicare Supplement (Medigap)?

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Medicare Advantage generally provides the same coverage as Original Medicare and can include additional coverage types like vision and dental insurance, while Medicare Supplement insurance covers a portion of your out-of-pocket costs and some medical services that aren’t covered by Original Medicare at all.

Medicare Advantage and Medicare Supplement plans are both sold by private insurers but you can’t have both at the same time. Keep reading for more Medicare Advantage vs. Medicare Supplement comparisons to help you decide which type of plan is best for you.

Key Takeaways

  • Medicare Advantage, or Medicare Part C, is administered by private insurance carriers and often includes all of the other parts of Medicare plus extra coverage types like vision and dental insurance.
  • Medicare Supplement insurance, or Medigap, is a private option that helps cover your out-of-pocket costs for Original Medicare and provides coverage for some otherwise excluded healthcare services.
  • Though both coverage options require you to already be on Medicare Parts A and B, you cannot have both Medicare Advantage and Medigap.
  • Medicare Advantage often doesn’t have a premium besides your Part B premium, while Medigap comes with a premium that depends on your location, insurance company, plan type and age.
  • Medicare Supplement insurance is compatible with every medical provider in the U.S. that accepts Medicare, while Medicare Advantage coverage may be limited to a smaller network of medical providers.

What Is a Medicare Advantage Plan?

Also known as Medicare Part C, Medicare Advantage is a type of health insurance plan administered by a private insurance company as an alternative to Medicare coverage managed by the federal government. Medicare Advantage typically includes all of the other parts of Medicare, making it a private option that can effectively replace Original Medicare for eligible customers.

All Medicare Part C plans cover inpatient hospital care (Part A) and outpatient medical services (Part B), with most of them also including prescription drug coverage (Part D). In addition, many Medicare Advantage plans come with extra coverage types that aren’t included in Original Medicare such as vision, dental, hearing and gym membership coverage.

Keep in mind that each insurance carrier has its own network of doctors, hospitals and other healthcare providers that it contracts with to provide medical services to its policyholders. As a result, your Medicare Advantage plan may only cover in-network care or require you to pay a higher portion of the costs for out-of-network care.

Who Is Eligible for Medicare Advantage?

You can only join a Medicare Advantage plan if you already have Medicare Parts A and B, which means you must meet the general Medicare eligibility requirements of being at least 65 years old or having a disability, permanent kidney failure or amyotrophic lateral sclerosis (ALS).[1] To qualify for a certain Medicare Advantage plan, you must also be a citizen or lawful resident of the United States living in that plan’s service area.[2]

How Much Does Medicare Advantage Cost?

The majority of Medicare Advantage plans don’t come with a premium, meaning members are only required to pay their Part B premium. Among plans that do require a separate Part C premium, the average cost for Medicare Advantage is $57 per month.[3]

Medicare Part B generally costs $164.90 to $560.50 per month depending on your income, although there are some Medicare Advantage plans that will pay all or part of your Part B premium.[4][5] Meanwhile, most Medicare members get Part A at no cost but those who don’t qualify for free coverage will have to pay either $278 or $506 per month.[4]

How To Choose the Right Medicare Advantage Plan

Cost and coverage are two of the most important factors to consider when shopping for a Medicare Advantage plan. Before settling on a plan, pay attention to whether that plan comes with an additional premium for Part C or if you would have to buy prescription drug coverage separately. You should also consider whether the plan includes vision insurance, dental insurance or any other type of optional coverage you are interested in and can afford.

Since private insurance companies partner with far fewer medical providers than the federal government, it’s important to check whether any doctors you currently go to are in a Medicare Advantage plan’s network before committing to that plan.

In addition, Medicare only covers care received outside of the United States in extremely limited circumstances, so you may want to look for a Part C plan with extra travel coverage if you frequently visit other countries.

What Is Medicare Supplement Insurance?

Also known as Medigap, Medicare Supplement insurance helps fill in the gaps in Original Medicare by paying part of your share of the costs. In some cases, a Medigap plan can also extend your coverage to pay for treatments that wouldn’t be covered at all under Original Medicare.

Every type of Medigap plan covers your Part A coinsurance and all or some of your Part B coinsurance or copays. Meanwhile, most Medicare Supplement plans cover all or part of your Part A deductible. Medigap Plans C and F also cover your Part B deductible, although these two plans are only available to people who qualified for Medicare before 2020.[6]

Although Medigap is sold by private health insurance companies, you cannot purchase it unless you are also on Original Medicare. As a result, Medicare Supplement plans cover services from every healthcare provider in the United States that accepts Medicare.[7]

Who Is Eligible for Medicare Supplement Insurance?

In general, you can purchase Medicare Supplement insurance if you meet the eligibility requirements for Medicare and have enrolled in Parts A and B already, although you should note that you aren’t allowed to have both Medicare Advantage and Medigap.[8]

You are only eligible for guaranteed issue coverage during your Medigap open enrollment period, which is a six-month window beginning the first day of the month when you are at least 65 years old and have signed up for Medicare Part B.[9] Otherwise, you will have to undergo medical underwriting and could face higher rates or be denied Medicare Supplement coverage depending on the results of your medical exam.

How Much Does Medicare Supplement Insurance Cost?

Medicare Supplement premiums can vary significantly depending on your insurer and the type of plan you select. For example, the cost of a Medigap plan in Connecticut can range from less than $50 to more than $1,200 per month.[10]

Medigap prices may also depend on your age and the rating method your insurance company uses. The cost of an issue-age-rated plan depends on how old you are when you buy the policy, while the premium for an attained-age-rated plan depends on your current age and will accordingly increase over time. Conversely, community-rated plans cost the same for all policyholders regardless of age.[11]

How To Choose the Right Medicare Supplement Plan

Like you would with Medicare Advantage, you should primarily pay attention to price and depth of coverage when shopping for Medicare Supplement plans. Comparing Medigap quotes from different insurance providers is generally straightforward since every Medigap plan with the same letter name offers the exact same coverage.[7]

So, while you may take an insurer’s customer satisfaction or financial strength ratings into account, the cheapest option will most often be the best option.

You may also want to note that, once you meet a $250 deductible, most Medigap plans will cover 80% of the costs associated with receiving medically necessary emergency care outside of the United States.[12] As a result, Medicare Supplement insurance may be your best bet if you frequently travel out of country since Original Medicare rarely covers international care and not every Medicare Advantage plan includes travel coverage.

What Are the Differences Between Medicare Advantage and Medicare Supplement?

See the below table and infographic for more direct comparisons between Medicare Advantage and Medicare Supplement insurance.

 

Medicare Advantage

Medicare Supplement

Coverage

Always includes Medicare Parts A and B, usually includes Part D and can include other coverages such as vision and dental insurance

Part of your out-of-pocket costs plus some services not covered by Original Medicare (e.g. emergency care outside of the U.S.)

Program Administrator

Private insurance companies

Private insurance companies

Network

Limited to providers that contract with your insurance company

Every provider that accepts Medicare

Open Enrollment Dates

January 1 to March 31

The first day of the month you are at least 65 years old and have enrolled in Medicare Part B to six months afterward

comparison between medicare advantage part c and medicare supplement medicap illustrations

How To Enroll in a Medicare Plan

You can sign up for Medicare online or over the phone through the Social Security Administration. Your initial enrollment period is a seven-month window that begins three months before the month you turn 65. Afterward, you can make changes to your Medicare coverage during open enrollment, which lasts from October 15 to December 7, or anytime a qualifying life event triggers a special enrollment period.[13]

If you miss open enrollment, you can also sign up for a new Medicare plan during general enrollment from January 1 to March 31, although you may have to pay a late enrollment fee if you sign up during this time frame.[14] Read below to see how you can sign up for Medicare Part C or Medigap once you’ve enrolled in Parts A and B.

Medicare Advantage

To find the right Medicare Advantage plan, you should compare quotes from at least three to five health insurance companies. Instead of contacting each insurer individually, you can streamline the process by using an insurance marketplace like SmartFinancial.

If you type your zip code below, we’ll ask you questions about your coverage needs and budget and then share this information with health insurance agents in your area. From there, you can start receiving free Medicare quotes in as little as a few minutes and decide which insurer you’d like to buy a policy from.

You can join a new Medicare Advantage plan or make changes to your coverage at any point during your first three months on Medicare. Afterward, you can only adjust your coverage during Medicare Advantage open enrollment from January 1 to March 31.[13]

Medicare Supplement (Medigap)

Medicare.gov allows you to put in your zip code and other personal information to find Medigap plans offered by insurance companies that operate in your area. The website shows you starting rates for various plans and contact information so you can reach out to an insurer to enroll in a plan.[15] Remember that it’s best to shop for Medicare Supplement coverage within six months of obtaining Medicare Part B so you can skip the medical underwriting process.

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Medicare Advantage vs. Medicare Supplement FAQs

Can you have a Medicare Advantage and Medicare Supplement plan?

No, you are not allowed to have both a Medicare Advantage and Medicare Supplement plan.[8]

When is Medicare open enrollment?

Medicare open enrollment lasts from October 15 to December 7.[13]

Are there penalties for canceling Medicare Advantage or Medicare Supplement?

If you cancel a Medicare Advantage or Supplement plan, there typically aren't cancellation fees. However, outside of special enrollment periods, you might have to wait until the next open enrollment to drop or switch Medicare Advantage plans and your health status could affect requalification for a new Medigap plan. 

Sources

  1. United States Department of Health and Human Services. “Who’s Eligible for Medicare?” Accessed Oct. 4, 2023.
  2. Centers for Medicare and Medicaid Services. “Understanding Medicare Advantage Plans,” Page 12. Accessed Oct. 4, 2023.
  3. KFF. “Medicare Advantage in 2023: Premiums, Out-of-Pocket Limits, Cost Sharing, Supplemental Benefits, Prior Authorization, and Star Ratings.” Accessed Oct. 4, 2023.
  4. Medicare.gov. “Costs.” Accessed Oct. 4, 2023.
  5. Medicare.gov. “Compare Original Medicare & Medicare Advantage.” Accessed Oct. 4, 2023.
  6. Medicare.gov. “Compare Medigap Plan Benefits.” Accessed Oct. 4, 2023.
  7. Medicare.gov. “Your Coverage Options.” Accessed Oct. 4, 2023.
  8. Medicare.gov. “Learn How Medigap Works.” Accessed Oct. 4, 2023.
  9. Medicare.gov. “When Can I Buy a Medigap Policy?” Accessed Oct. 4, 2023.
  10. Connecticut’s Official State Website. “Monthly Medicare Supplement Rates for Standardized Plans.” Accessed Oct. 4, 2023.
  11. Medicare.gov. “Costs of Medigap Policies.” Accessed Oct. 4, 2023.
  12. Centers for Medicare and Medicaid Services. “Medicare Coverage Outside the United States,” Page 3. Accessed Oct. 4, 2023.
  13. Medicare.gov. “Joining a Plan.” Accessed Oct. 4, 2023.
  14. Medicare.gov. “When Does Medicare Coverage Start?” Accessed Oct. 4, 2023.
  15. Medicare.gov. “Find a Medigap Policy That Works for You.” Accessed Oct. 4, 2023.

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