Medicare Health Plans:Medicare Advantage vs. Medigap

Read this before signing up for Medicare Advantage or Medigap

by Amy De Vore+ on Jul 17, 2014 | 4 Comments

Medicare health plans are Advantage and Supplemental plans for original Medicare Part A and Part B. There are two main options for seniors: Medicare Advantage, AKA Medicare Part C and Medicare Supplemental, AKA Medigap.

 

What is Medicare Advantage?

Medicare Advantage (Medicare Part C) replaces Original Medicare by limiting your network to a local, HMO-type network while adding extras like prescription drug coverage, dental, and vision. Medicare Advantage offers r low to no monthly premiums, usually subject to a deductible, copays, and coinsurance.

What is Medicare Supplement?

Medicare Supplement (Medigap) are standardized plans that fill in the gaps of Original Medicare. The benefit of being standardized is that all providers must offer the exact same coverage, and the you only need to shop by price.

Medigap can cover Medicare’s deductibles, copays, coinsurance, and offer additional coverage such as covering the first three pints of blood, extends hospitalization, and foreign emergency healthcare. These plans maintain Original Medicare’s nationwide network of doctors, this with the extended coverage generally makes the Medigap monthly premium higher than Medicare Advantage.

Part C or Medigap: Which covers more?

Making a decision between Medicare Part C and Medicare Supplement Insurance is really up to your needs and budget. For the greatest financial protection, our clients have found that Medigap, with many first-dollar coverage plans, limits their financial burden, however some clients find its monthly premium to be too expensive for their budget. For those clients, we suggest looking into a Medigap Plan F high-deductible (which offers the same coverage as Medigap’s most comprehensive plan, but with a deductible of $2,140 for 2014, but with a low monthly premium) or Medicare Advantage. The benefit of the MA plans are the inclusive Rx coverage.

Conclusion
For further help deciding between a Medigap and Medicare Advantage plan call the number above or if you’re ready to get started click here for a Medicare health plan quote.

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Reader Comments and Questions

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By Caren on October 25, 2016

I have Medicare A and B and Champva. Do I need Medicare advantage or anything else?

Caren,
If you have ChampVA you most likely will not need anything else. However, you will want to contact the VA to confirm.
-Amy from https://www.senior65.com/


By James Schaefer on September 01, 2016

I receive my medical care at a nearby VA Hospital and have Medicare, Parts A &B plus Medicare Supplement Plan F. I've contacted my Supplemental Insurance company and they stated that they had rejected ever claim presented by the VA because it had to go through Medicare first. I am happy with the care I receive at my VA Hospital, but could use the $165 monthly fee to my Supplemental insurance company myself, Since they are paying anything to the VA. If I cancel, what difference will it make?

James,
As you've found out, unfortunately, Medicare Supplement plans only pay for what Medicare doesn't pay, not the VA. However, the reason you may want to consider keeping your plan, is we've had a few veterans find that their local VA does not have the capability of treating their illness, or their percentage of coverage is lowered. If either of these happen, and you have dropped your Medigap policy, you will have to pay all of your Medicare costs out of pocket.

If you're interested in lowering your Medigap monthly costs, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By deborah haddock on August 21, 2016

Ok I really confused. I am close to turning 65, applied for Medicare and I have received y card but it states it is for Plan A only. I also am a veteran but pay for medicine and doctor visits, because of my income is to high to qualify for no cost care. So I am not sure what I need to apply for. If I retire at 66 my income will dramatically be reduced. So, any help will be appreciated. I have been receiving mass amounts of mail from insurance companies in regards to insurance. Again thank you for your help.

Deborah,
Most likely you were not automatically signed up for Part B because you're still working and not collecting Social Security. Not to worry, if you have job-based creditable coverage (VA coverage is not considered creditable coverage), you can enroll in Part B down the line, and not owe a penalty, as well as, you will be able to enroll in a Medigap plan without having to answer medical questions.

Now, if you don't want to collect Social Security now, but don't have job-based insurance, you will want to apply for Part B from Medicare, and look into either a Medigap or Medicare Advantage plan. If you need help with a Medicare Health Plan call one of our Senior65 licensed independent insurance agent at 800-930-7956.
-Michelle from https://www.senior65.com/


By Jeannie on May 30, 2016

My mom will be 75yrs old in August. She uses VA for everything and is pretty healthy. Recently discovered she never signed up for Medicare when she turned 65 yrs. I am concerned if she ever had an accident and had to go to emergency room would she be covered by VA especially if she goes to a non-VA hospital? She herself is the veteran. Really concerned if she signs up for Medicare now how much her payments will be. Any advise?

Jeannie,
We understand your concern. There are two things your mother will need to do.
  • Contact her VA facility to see how they cover emergencies outside of the VA
  • Contact Medicare to see if she qualifies for any type of Special Enrollment
If she does not qualify for a Special Enrollment period, she will need to wait until the Medicare General Election Period (Jan 1-March 31) which has an effective date of July 1. She will also owe a Part B penalty for late enrollment, and possibly a Part A penalty.

Senior65 and the VA highly recommend that you maintain enrollment in Medicare. Hope this helps!
-Amy from https://www.senior65.com/


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