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Medigap / Medicare Advantage Comparison

There are many differences between Medicare Advantage Plans, also known as Medicare Part C, and Medicare Supplement (Medi-gap) Plans. The table below lists some major differences between the two. It is important to understand the differences as the choice you select can have a tremendous impact on how you receive Medicare benefits.

Medigap / Medicare Advantage Comparison

MEDIGAP PLANS vs. MEDICARE ADVANTAGE PLANS

MEDICARE ADVANTAGE
(PART C)
MEDICARE SUPPLEMENT
(MEDIGAP) PLANS
WHO PROVIDES COVERAGE? Private Insurance Companies Private Insurance Companies
HOW ARE PLANS FUNDED? Subsidies from Medicare and the beneficiary’s PART B premium. The plan may also charge a premium to the member. Premiums are paid by the policyholder.
DO I STILL HAVE TO PAY MY PART B PREMIUM? YES YES
IS THE POLICY GUARANTEED RENEWABLE? NO. Policies are renewed on annual based on approval from the Centers for Medicare Services (CMS) YES. Policies can only be terminated if you do not pay your premium on time, or you made a material misrepresentation.
WHAT DOES THE POLICY COVER? By law, MA plans are required to cover at least what Original Medicare (PARTS & B) cover. Most plans cover additional benefits not covered by Medicare. By law, Medicare Supplement plans are standardized for all carriers. Each plan will offer the same benefits regardless of the carrier you choose.
WHAT OPTIONS ARE AVAILABLE? The insurance carrier usually offers a variety of plan options with different copayments and deductibles. Most include prescription drug drug, and some have dental and/or vision coverage. See Medicare Supplement Plan Benefit Summaries
CAN I USE MY OWN DOCTORS/HOSPITALS? NO. You must use providers in your selected plan’s network unless it is a medical emergency. YES
IS PRE-CERTIFICATION REQUIRED? Usually, YES. Also known as “prior authorization”. See the respective plan’s guidelines for pre-certification requirements. NO
The information in this table has been compiled from different sources including, but not limited to, medicare.gov, cms.gov, & Choosing a Medigap Policy Guide

Need To Change Medicare Advantage Plans?

Special Enrollment Periods(SEP) allow you to make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, such as moving or losing other insurance coverage. Rules about when you can make changes and the type of changes you can make are different for each SEP. Contact us today to learn more.