The Difference Between Medigap and Medicare Advantage

Original Medicare can come with high costs. If you want more coverage than Original Medicare provides there are two choices. Let’s go over Medicare Medigap and Medicare Advantage. You can add a Medigap plan to Original Medicare. Or you can buy a Medicare Advantage plan. Both plan types offer more coverage than Original Medicare. You need to know how the plans are different.

"Choosing whether to go with Medigap or a Medicare Advantage plan is really a personal choice," says Ellen Galardy, Vice President of Senior Markets Product and Strategy at Highmark Health. "We always recommend that you speak with an insurance agent to find the plan that best fits your needs. But before you have that conversation, you should understand the options."

Answer the following questions to see which plan is right for you:

Do you prefer à la carte coverage or a package deal?

Medicare Advantage plans roll all your coverage into one plan. Medicare Advantage plans also cover nurse case managers.  allowing you to make just one decision. A case manager can help you manage a chronic condition. They also support your wellness goals. The plans offer other wellness benefits, too.  You can change your plan once a year no matter your age or medical condition. Open enrollment takes place from Oct. 15 through Dec. 7.

Medicare Medigap plans pay for Original Medicare deductibles. They also pay for Original Medicare coinsurance. But you may need to buy more coverage for prescription drugs, dental, or vision. Costs can add up but choosing each of your plans lets you personalize your coverage.

Think about your long-term needs when choosing your plan. Changing your plan in the future may result in higher rates. You may have fewer coverage options based on age or new medical conditions. Look for a Medicare Medigap plan that will work for you for a long time.

Does your spending style suit Medicare Medigap plans?

With Medicare Advantage plans, monthly premiums are low. Premiums for each plan are the same for every person. This is regardless of age or health history. Since you’ll only pay for the health care you use, you’ll get a lot of savings upfront. You’ll have to pay copayments and coinsurance, which can change each month. There is a cap on total spending, though most members do not reach that cap. If you don’t choose Medigap during your initial enrollment period, and want to do so later on, medical underwriting may be required to complete the process.

Medigap and Medicare Advantage plans use different approaches to spending. Medigap plans have larger monthly premiums. But you’ll pay very little when you visit a provider. It’s easy to budget for your health care with Medicare Medigap plans. You’ll know exactly how much you’ll pay each month.

What are your provider needs?

Think about the providers you see and your lifestyle. With Medicare Medigap, you can visit any doctors or hospitals in the U.S. if they accept Medicare. This is a bonus if you travel a lot, or don’t want to worry about whether your provider is in-network.

Medicare Advantage plans take advantage of a defined provider network. This is where plans partner with trusted doctors and hospitals to offer you high-quality services at a lower cost. Other companies, like Highmark, may also cover costs for you to visit providers outside of your plan’s network. Seeing in-network providers is usually less expensive.  But you may have preferred providers you want to see instead. Check the plan’s provider directory and out-of-network benefits before choosing a Medicare Advantage plan. This will help keep your costs to a minimum.

Galardy believes the best choice is the plan that fits your lifestyle and budget needs. "In Pennsylvania, about fifty percent of people are choosing a Medicare Advantage plan, which means the other half are likely to choose Medigap," says Galardy. "Medigap and Medicare Advantage both provide good options, but it’s important to find the right fit for your unique preferences."

Learn the difference between Medigap and Medicare Advantage

Schedule a personal consultation with a Highmark Licensed Medicare Advisor or call 866-994-1168 (TTY users call 711) October 1 - March 31, 8 am - 8 pm, 7 days a week.

April 1 - September 30, 8 am - 8 pm Monday through Friday