Medicare options with Confidence

Medicare Advantage, also called Medicare Part C, is an alternative way to receive Medicare benefits. These plans are offered by private insurance companies approved by Medicare and provide Medicare Part A and Part B coverage. Most plans also include prescription drug coverage, and some offer additional benefits such as routine dental, vision, or hearing services. 

Medicare Supplement Insurance, commonly called Medigap, works alongside Original Medicare. It helps pay certain out-of-pocket costs that Original Medicare does not pay, such as deductibles, copayments, and coinsurance. Medigap policies are sold by private insurance companies. 

Medicare Advantage replaces Original Medicare as the way you receive Medicare-covered services. Medigap supplements Original Medicare by helping pay some of your remaining costs. 

No. Medigap does not work with Medicare Advantage and cannot pay a Medicare Advantage plan’s deductibles, copayments, coinsurance, or premiums. In general, an insurance company cannot sell you a Medigap policy while you are enrolled in Medicare Advantage unless you are returning to Original Medicare. 

Yes. Whether you select Medicare Advantage or Original Medicare with Medigap, you generally must continue paying your Medicare Part B premium. You may also pay a separate premium for your Medicare Advantage or Medigap coverage.

Most Medicare Advantage plans include Medicare Part D prescription drug coverage, but not all do. Always confirm that your medications are covered and that your preferred pharmacies participate in the plan.

No. Medigap policies sold today do not include prescription drug coverage. If you choose Original Medicare with Medigap, you can purchase a separate Medicare Part D plan. 

With Original Medicare and Medigap, you can generally visit any doctor or hospital in the United States that accepts Medicare.

Medicare Advantage plans may use provider networks. Depending on the plan, receiving non-emergency care outside the network may cost more or may not be covered. Some plans also require referrals or prior authorization for certain services.

It depends on your medical needs and the plans available where you live.

Medicare Advantage plans may have low or even $0 additional monthly premiums, but members can owe copayments, coinsurance, and deductibles when they receive care. Medigap usually has a separate monthly premium but may make Medicare-covered healthcare expenses more predictable.

Compare total expected costs—not just the monthly premium.

Medicare Advantage plans have an annual limit on members’ out-of-pocket costs for covered Part A and Part B services. The limit varies by plan.

Original Medicare does not have an annual out-of-pocket limit. A Medigap policy can substantially reduce the costs left by Original Medicare, depending on the policy selected.

Some Medicare Advantage plans offer additional dental, vision, and hearing benefits. Coverage limits and provider requirements vary.

Standard Medigap policies generally do not cover routine dental, vision, or hearing care. Separate coverage may be available.

Original Medicare with Medigap generally provides broad access to Medicare-participating providers throughout the United States. Certain Medigap policies also cover limited emergency medical care during foreign travel.

Medicare Advantage plans must cover emergency and urgently needed care, but routine non-emergency coverage may be limited to the plan’s service area or provider network. Check the plan’s travel rules before enrolling.

Your federal six-month Medigap Open Enrollment Period generally begins the first month you are both age 65 or older and enrolled in Medicare Part B. During this period, insurers generally cannot deny coverage or charge more because of your health.

Outside this period, an insurer may use medical underwriting, charge more, or decline your application unless you have a guaranteed-issue right. State protections may provide additional opportunities.

You may leave Medicare Advantage during an applicable Medicare enrollment period. However, eligibility to purchase Medigap is a separate issue. Unless you have a trial right, guaranteed-issue protection, or additional rights under state law, an insurer may evaluate your health and could decline your Medigap application. 

Confirm your Medigap eligibility before ending existing coverage. 

Consider:

• Your doctors, hospitals, and preferred pharmacies
• Your prescription medications
• Monthly premiums and potential out-of-pocket expenses
• Provider-network and prior-authorization requirements
• How often you travel
• Additional dental, vision, or hearing benefits
• Whether you qualify to purchase Medigap without medical underwriting

Review each plan’s official documents because benefits, costs, networks, formularies, and rules can change annually.