Is it better to have Medicare Advantage or Medigap? This is a common question that we hear from our patient community here at Meadowcrest Family Physicians.
If you’re new to the world of Medicare, you may not fully understand all the reasons why beneficiaries look for coverage beyond traditional Part A and Part B Medicare. To put it simply, traditional Medicare by itself covers a variety of medical services, but it may not provide complete protection or cost coverage of medical expenses. For this reason, many beneficiaries choose to enroll in the more comprehensive Medicare Advantage plans, or they may purchase additional insurance via Medigap to cover the gaps that traditional Medicare doesn’t. In this post, we’ll take a closer look at how these two options differ. We’ll also look at Special Needs Plans (SNPs) – a needs-based option that allows eligible patients to enroll in Medicare Advantage throughout the year.
An Overview of Medigap (Medicare Supplement) and Medicare Advantage (Part C)
Medigap, which is also called Medicare Supplement, is a type of add-on Medicare insurance that is sold by private insurance companies. In order to purchase Medigap, beneficiaries must remain enrolled in Part A and Part B Medicare. They will also need Part D or another stand-alone plan which provides prescription drug coverage, as Medigap does not cover prescription drugs.
There are 10 different Medigap policies to choose from, which are titled A-N in most states. Each of these offers different coverage options, but the main thing that all Medigap plans have in common is 100% coverage for Part A coinsurance & hospital costs.
The other common alternative for Medicare beneficiaries is a Medicare Advantage plan. Also known as Part C, Medicare Advantage plans are a top choice since they offer all-in-one comprehensive coverage. These plans typically include the medical services covered in Parts A and B of traditional Medicare, as well as Part D prescription drug coverage on most plans and some additional medical services for dental, vision, and hearing. These plans are often structured like a network of providers, requiring beneficiaries to visit in-network medical facilities to receive full coverage.
Weighing the Pros and Cons
Without considering the pros and cons, it’s not easy to answer the question, “Is it better to have Medicare Advantage or Medigap?” To provide some clarity, we have compiled some of the high-level pros and cons for each:
Medigap (Supplemental Medicare)
|Pros of Medigap||Cons of Medigap|
Medicare Advantage (Part C)
|Pros of Medicare Advantage||Cons of Medicare Advantage|
Special Needs Plans
Another option to consider is whether you are eligible for a Special Needs Plan. If so, you are not limited to the usual Open Enrollment period to make changes. Instead, you can enroll in Medicare Advantage at any time of the year!
The three types of SNPs are listed below. For a more detailed explanation, see our blog post that answers FAQs about Medicare Advantage Open Enrollment.
- Chronic Condition SNP (C-SNPs): These SNPs cover beneficiaries who live with chronic diagnoses, such as diabetes, dementia, or chronic heart failure.
- Dual Eligible SNP (D-SNPs): These SNPs are based on income and are for beneficiaries who qualify for both Medicare and Medicaid.
- Institutional (I-SNPs): If you require care for 90 days or more–either in a qualifying long-term care facility or you require nursing home-equivalent care at home or in a care facility–then you may qualify for an I-SNP.
So, is it better to have Medicare Advantage or Medigap?
While we have seen a lot of patient satisfaction in switching to Medicare Advantage plans, we realize that the answer to this question really depends on your individual medical needs, budget, and preferences. If you have unique considerations and want to talk about your specific circumstances, please get in touch. At Meadowcrest Family Physicians, we pride ourselves on top patient care and we are here to help!