Overwhelmed? A Quick but Thorough Guide to Medicare Advantage vs Medigap


Sixty-five percent of American seniors either continue to work or plan to keep working past their 65th birthdays. For many, this means that their private health insurance coverage will carry on, as well. Even working seniors need to make decisions about their Medicare coverage, however. 

If you’re in that boat and wondering about Medicare Advantage vs Medigap and which is best for you, keep reading now for a quick but thorough guide to all the things you need to know. 

Medicare Advantage 101

Medicare Advantage Plans, also called Medicare Part C, are comprehensive health insurance plans that combine Medicare Parts A, C, and D into a single plan. These plans are offered by independent, Medicare-approved insurance providers. All plans must meet minimum coverage criteria, ensuring adequate coverage for enrollees. 

Advantage Plans tend to be structured as HMOs or PPOs and often have very reasonable premiums. They provide hospital and general health coverage, as well as prescription drug coverage. They may also offer coverage for services not traditionally covered by Medicare Parts A, B, and D such as: 

Advantage Plan costs and coverage can vary, so it is important to review all the options before selecting one. 

Medigap 101

Medigap Plans are health insurance plans offered by private insurance companies independent of the Medicare program. Within each state, plans are standardized into 10 categories.

Each category is assigned a letter and all plans under the same letter offer the same coverage. This makes comparing plans and their costs easy. 

Medigap Plans are a form of supplemental insurance, designed to help enrollees with the costs of services not covered by traditional Medicare. Medigap coverage kicks in after Medicare has paid for its share of qualifying medical costs or when enrollees face costs covered by the Medigap Plan but not Medicare. 

Specifically, Medigap Plans help enrollees pay for costly care such as emergency care during international travel and skilled nursing facility or long-term care expenses that Medicare does not cover. 

Medicare Advantage vs Medigap

When choosing between a Medicare Advantage Plan vs Medigap insurance, there are a few key questions to ask. 

The first question when choosing between Medicare Advantage vs Medigap insurance is whether you travel regularly. Seniors who regularly go out of the country will benefit from Medigap’s foreign emergency care coverage. 

The second question is whether you anticipate needing to stay in a long-term or skilled nursing care facility. If so, Medigap is again most likely to provide the coverage you need. 

On the other hand, you may decide the Medicare Advantage Plan vs Medigap Plan question in favor of Medicare Advantage if you answer “no” to both of those questions. 

Do You Have to Choose?

You cannot have both Medicare Advantage and Medigap plans at the same time. You can, however, switch between them during the annual open enrollment period or when you experience a qualifying life change. 

Before choosing a Medicare Advantage Plan vs Medigap Plan, it is best to fully explore your options and costs. You can get help drilling down into the details on MedicareWire

Learn More 

Learn more about the Medicare Advantage vs Medigap debate and other critical health issues in our health section today.