These two policies both cover gaps within Medicare, yet work differently in doing so.
Medigap (Medicare Supplements)
For Medicare supplements, they pay once Medicare has paid for their share of a bill. If you are on Medigap you are still on Original Medicare. Whenever a bill is received from any health clinic, doctor, hospital, etc. Medicare covers whatever they have to and any excess is then sent to the Medicare Supplement company you have chosen. Depending on the plan taken with the Medigap company depends on how much the company will pay towards the bill.
Medicare Advantage plans are a separate entity from Medicare. Benefits come from your Advantage plan rather than from Medicare itself. Within the Advantage plan, you use the network providers from an HMO or PPO plan unless it is an emergency. Also, copays are expected to be paid by you for health care.
Supplement Plans Continued
Medicare supplement plans as stated before are secondary to your Original Medicare. With Medigap, any Medicare provider is available to you without needing a referral. Enrolling in a Plan G with saving on out-of-pocket costs and doctor copayments. Once you have enrolled in a Medicare Supplement plan, Medicare is then notified of your purchase and any bills not fully taken care of by Medicare are handed off to the company you chose to pay the rest off. The supplement plans allow one to go to any hospitals or doctors in the U.S. Not only that, a referral will not be needed either to see a specialist. That being said, the plans’ premiums are higher than a Medicare Advantage plan.
The Medigap plans will cover drugs that have been given in a hospital/clinic area, but will not cover prescribed medications outside of the hospital setting. Most clients enrolled in a Medigap plan end up paying for a separate Part D drug plan in order to have coverage for prescription drugs.
Don’t forget, enroll during your open enrollment window which is from the start of your Part B Medicare effective date and six months after to be approved with no health questioning.
Medicare Advantage policies are private insurance plans which can have low premiums compared to Medigap plans and even the possibility of a $0 premium.
Part B premiums are paid for on a monthly basis by you and you have to be on Medicare Part A and B for eligibility to get on a Medicare Advantage Plan. A $0 premium plan usually means that the network providers for the plan have less doctors to choose from when comparing it to a Medigap plan. Plus the insurance company controls the choice of providers given to you.
If you already have a doctor you go to for checkups, check to see if they are within the network of the plan you are looking at. The HMO plan has a small network so if you choose this be sure to double-check and see where you would have to go for checkups if the primary care physician you go to is not in the network.
The insurance companies that sell Medicare Advantage Plans pay for the healthcare bills rather than Medicare itself paying for them. If you are on a Medicare Advantage plan then you pay the copays that come from the services you use within the network.
Only one health question is on a Medicare Advantage application and that is if you have End-Stage Renal Disease which would disqualify you from obtaining Medicare Advantage plans. In the year 2021, there are no questions pertaining to health on any Medicare Advantage plan applications.
Most Medicare Advantage plans do come with a Part D drug plan attached so unlike Medigap you do not need to purchase a separate drug plan. Be sure to check and make sure there is a Part D attached, on the off chance it is not you need to talk with a Medicare Supplement agent to see what the next steps to take are.
There is a maximum out-of-pocket policy in place on all Medicare Advantage plans to protect you from spending too much. As of 2021, the maximum limit cannot be higher than $7,550.