Original Medicare with a Medigap vs. Medicare Advantage

Original Medicare

with a Medigap vs.

Medicare Advantage

People with Medicare looking to fill gaps in their coverage and/or get assistance with

Medicare costs can choose to enroll in a supplemental insurance policy (Medigap) in

addition to Original Medicare or to enroll in a Medicare Advantage Plan. Here’s a look at the

differences between these two options.

Medigaps may help pay for Medicare deductibles,

coinsurances, and copayments. Depending on where

you live, and when you became eligible for Medicare,

you have up to 10 different Medigap plans to choose

from: A, B, C, D, F, G, K, L, M, and N. (Plans in

Wisconsin, Massachusetts, and Minnesota have

different names.) Each lettered Medigap offers a

different set of benefits, but all plans with the same

letter must offer the same benefits (regardless of the

company you buy it from). Premiums vary, depending

on both the plan you choose and the company you

buy it from.

Medicare Advantage Plans must provide at least the

same set of benefits offered by Original Medicare, but

they may have different rules, costs, and restrictions.

For instance, Medicare Advantage Plans may require

that you see health care providers in their network,

and/or that you get a referral from your doctor before

seeing specialists. Some MA Plans offer extra,

Medicare-excluded benefits, such as dental care.

If you sign up for Original Medicare and a Medigap and later decide you would like to try a

Medicare Advantage Plan–or vice versa–be aware that there are certain enrollment periods

when you are allowed to make changes. Additionally, Medigap enrollment rules vary by

state. Familiarize yourself with your state’s rules before disenrolling from your Medigap.

Keep in mind that different areas have different Medicare Advantage Plans and Medigap

options. A particular plan may not be available where you live. For assistance finding

Medicare Advantage Plans in your area, call 1-800-MEDICARE (633-4227) or your State

Health Insurance Assistance Program (SHIP). To learn about Medigap availability and

enrollment in your state, call your SHIP or Department of Insurance.

Medigap

Policies that provide insurance

through private companies and

help fill cost-sharing gaps

Medicare Advantage

Private plans that contract

with the federal government

to provide Medicare benefits

The table below compares Original Medicare with a Medigap and Medicare Advantage.

Remember that there are several different kinds of plans. If you are interested in joining a

plan, make sure to speak to a plan representative for more information.

Medigap

Medicare Advantage

Cost-sharing

Pays part or all of certain

remaining costs after Original

Medicare pays first.

Cost-sharing varies depending on

plan. Usually pay a copay for in-

network care. Make sure to

compare a particular plan’s cost-

sharing to Original Medicare.

Premium

Plans charge a monthly premium

in addition to the Part B premium.

Plans may charge a monthly

premium in addition to the Part B

premium.

Provider access

See any provider and use any

facility that accepts Medicare.

(Note: If you have a Medicare

SELECT plan, you must use your

Medigap plan’s network)

Typically see only in-network

providers.

Referrals

Do not need referrals for

specialists.

Typically need referrals for

specialists.

Other benefits

Generally only covers Medicare

cost-sharing. However, may cover

costs Medicare does not cover at

all, like 365 additional lifetime days

for hospital or care received when

traveling abroad.

May cover additional services,

including vision, hearing, and

dental (additional benefits may

increase your premium or other

out-of-pocket costs).

Enrollment

In most states, insurance

companies must only sell you a

policy at certain times and if you

meet certain requirements. Call

your SHIP or Department of

Insurance for more information.

May use the Fall Open

Enrollment Period (October 15

through December 7) to pick a

new Medicare Advantage Plan or

switch between Original Medicare

and Medicare Advantage.

Definitions

Premium: The monthly fee you pay to have Medicare.

Deductible: What you must pay out of pocket before Medicare starts paying for your care.

Copayment / Coinsurance: The amount you pay for each service.

Participating provider: Provider that accepts Medicare’s approved amount for services as full

payment.

Network: Doctors, hospitals, and medical facilities that contract with a plan to provide services.