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Differences Between Medicare Advantage Vs Medigap plans?

Medigap vs Medicare Advantage learn the differences. Private companies offer you Medicare Advantage plans and your coverage may be limited to a network of providers. However, the federal government offers you Medicare and provides nationwide coverage.

Medicare Supplements (Medigap plans) work with Medicare (not Medicare Advantage). Original Medicare may only cover 80% of your hospital and medical services. Medicare Supplement plans cover some or all of these coverage gaps depending on the Medigap plan.

Choosing between Medigap and Medicare Advantage plans requires getting into the details and comparing the pros and cons of each for your specific circumstances. Read on for more information you can use to compare Medigap and Medicare Advantage plans so you can make the most informed decision.

Medigap vs Medicare Advantage (MA): Medicare Supplement plans provide you with nationwide coverage. However, MA plans provides you with local (HMO) or regional (PPO) coverage.


MA plan differences: For non-emergency and non-critical care, doctors outside an HMO network are not covered and specialists require referrals. However, doctors outside of a PPO network are allowed but may cost you more.The 2022 chart below shows you several differences between Medicare Advantage vs Medicare Supplement.

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Medigap vs Medicare Advantage Cost Differences

Medicare Advantage and Medicare Supplement (Medigap) plans require you to have Medicare Part B. Starting January 1, 2020, all Medigap Plans require beneficiaries new to Medicare to pay Part B premiums. However, beneficiaries with Medigap Plans C and F do not pay Part B.

Some Medicare Advantage Plans may pay all or part of your Part B premium.

Advantage Vs Supplement Plan Premiums

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Medicare Advantage Plan premiums will vary based on
coverage and the insurance carrier. However, CMS.gov reports,
“historically low premiums in Medicare Advantage.” Furthermore, you have
more than 1,600 prescription drug plans from which to choose. We can
help you find the right Medicare Advantage plan. Call Senior Healthcare
Direct and speak to a licensed agent at 1-833-463-3262 or get your quote.

Medicare Supplements pay part or all of your Part A and
Part B expenses. For example, Medigap Plan G covers 100% of your
hospital and medical services after you pay a $233 Part B deductible in
2022. Plan G is the most comprehensive coverage available for people new
to Medicare on or after January 1, 2020. You can shop Medigap Plans by
calling Senior Healthcare Direct at 1-833-463-3262 or get your quote.

Medical Underwriting: Medigap vs Medicare Advantage

For coverage starting January 1, 2022, Medicare Advantage Plans accept all health conditions, including End-Stage Renal Disease (ESRD). Likewise, you can enroll in Medicare Supplement Plan without medical underwriting during your initial Open Enrollment Period (OEP). In other words, there is no medical underwriting when you are first eligible for Medicare, which includes:

  • Three months before the Month you turn 65

  • The month you turn 65

  • Three months after the Month you turn 65

However, anytime after your initial Open Enrollment Period, medical underwriting is required. For example, you switch to a different Medigap Plan after your initial OEP.

Prescription Drugs – Advantage vs Supplement

Medicare Advantage Plans such as HMO and PPO most often
include prescription drug coverage. However, Advantage Plans are not
required to cover prescription drugs. If your HMO or PPO does not
provide drug coverage and you enroll in a separate Medicare Prescription
Drug Plan, you will be disenrolled from your Medicare Advantage Plan.

Medicare Supplement Plans fills in the coinsurance and
deductible coverage gaps of Original Medicare, which does not cover
prescription drugs. To get drug coverage, you need to enroll in a
separate Part D drug plan. Senior Healthcare Direct can help you find
the right drug plan that includes all your prescriptions.

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Outstanding Customer Service Team

Getting the right Medicare coverage is just the first step. When you work with Senior Healthcare Direct, we provide you with outstanding customer support for the life of your Medicare policy. We have a dedicated Customer Service Team of 10 full-time employees on call to quickly work to resolve your Medicare issues. Our support team will work to fix your billing errors.

Furthermore, we write Medicare appeals and solve pharmacy exceptions when you can’t get your medication. Moreover, many of our support team are seniors themselves and have years of Medicare knowledge and experience helping Medicare beneficiaries. Discover six principle reasons to do business with our Medicare insurance company.

Max Out-of-Pocket Limits: Medigap vs Medicare Advantage

The last difference between Medigap vs Medicare Advantage is max out-of-pocket limits.

The Medicare Advantage maximum out-of-pocket (MOOP) limit for in-network services in 2022 has remained the same at $7,550. Once you reach this MOOP limit, your Medicare Advantage plan will cover all costs until the end of the year.

All Medicare Supplement Plans cover most or all of your out-of-pocket costs except plans K and L. Thus, CMS.gov put the following out-of-pocket 2022 limits on plans K and L.

  • $6,620 for Plan K ($400 increase from 2021)

  • $3,310 for Plan L ($200 increase from 2021)

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