Medicare Supplement vs. Medicare Advantage

Many clients that I speak to never quite understand the difference between a Medigap “Medicare supplement” and a Medicare Advantage plan (Part C). They often get them mixed up so I wanted to take a moment just to try and clarify the differences.

I should also point out that Medicare Advantage Plans and Part C plans are exactly the same thing. Just like Medicare supplement plans and Medigap plans are the same, so I may use them interchangeably here.

Medicare Advantage

Let’s first take a look at Part C plans first. These plans are administered by private insurance companies and if you choose one of these plans, they become your primary insurance. This does not mean you are no longer a member of Medicare and you also must continue to pay your Part B monthly premium. But what it does mean is that you will not pay the co-pays, deductibles, and coinsurance associated with Medicare A & B. Instead, you will pay the coinsurance and copays that the insurance carrier tells you to pay, based on your summary of benefit chart.

So, let’s say you have a Humana PPO, and you know the primary doctor co-pay is $10, directly out of your summary of benefits, then you will only pay the $10 co-pay for the visit. You will not pay what Medicare Part B would normally charge you because Humana is now your primary insurance.
Medicare Advantage plans also have a network of doctors and you must make sure that your doctor(s) are in the plan’s network if you want to see them. HMO’s and PPO’s are the most two common plans. In HMO’s, you must get a referral to see a specialist and with PPO’s you do not need a referral. Medicare Advantage plans generally will include your Part D drug coverage at no additional charge and sometimes they will include extra benefits such as Silver Sneakers, dental, vision, and hearing.
These plans can sound great when you factor in that they generally can be purchased with no monthly premium. That’s right, they get paid by Medicare and typically they don’t charge members for the plan. But, you must remember that you will have co-pays for most procedures and office visits, which could add up over time. Also, you must make sure that your doctors take the plan that you are looking at purchasing.

Medicare Supplement

Medicare supplement Plans or “Medigap” are nearly the complete polar opposite of a Medicare Advantage Plan. Medigap plans are secondary to Medicare Part A and Part B. Once Medicare pays their portion of approved charges, the Medigap plan will come in and cover most or all of whatever cost is leftover (depending on your plan choice).  These plans do have a monthly premium and it depends on your zip code and age to determine the cost. You can get a free immediate quote HERE. 

Medicare supplement plans do not have a network and you may go to ANY doctor nationwide as long as they accept Medicare. Your insurance plan does NOT determine which doctor or hospital you can go to.

Medigap plans also are not allowed to include Part D prescription drugs, dental, vision or hearing. These must be purchased separately.

Be sure to compare like to like plans when shopping plans. If you are looking at Plan G with one company, be sure to look at another company’s plan G as well to compare prices. All plans are created equal! This means that every Plan F or G or any letter is exactly the same, so long as you compare the same letter. Don’t pay more for company A if company B can save you hundreds per year.

Contact us

If you need further help or have any questions, feel free to give us a call at 800-352-9745.

Email at ChazMulherin@gmail.com or you can get a QUOTE