Medicare Supplement Insurance (Medigap)

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare.

• Generally, you need Part A and Part B to buy a Medigap policy.

• Some Medigap policies offer coverage when you travel outside the U.S.

• Generally, Medigap policies don’t cover long-term care (like care in a nursing home), vision, dental, hearing aids, private-duty nursing, or prescription drugs.

• If you’re under 65, you might not be able to buy a Medigap policy, or you may have to pay more.

Medigap policies are standardized, and in most states named by letters, like Plan G or Plan N. The benefits in each lettered plan are the same, no matter which insurance company sells it.

Price is the only difference between policies with the same letter sold by different companies.

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If you don’t buy a Medigap policy within 6 months of when you first get Part A and Part B, you may not be able to buy a policy or you may pay more. Generally, you need Part A and Part B to buy a Medigap policy.

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Things to Consider when choosing between Medigap and Medicare Advantage

When comparing Traditional Medicare or Original Medicare and Medicare Advantage (Part C), there are several key advantages of choosing Traditional Medicare over Medicare Advantage, depending on individual needs and preferences. Here are some of the benefits of opting for Original Medicare:

1. Freedom to Choose Providers
- Original Medicare allows you to see any doctor, specialist, or hospital that accepts Medicare, without needing referrals or staying within a network. This provides flexibility in choosing healthcare providers, especially if you travel or live in multiple locations.
- Medicare Advantage, on the other hand, typically requires you to use a network of doctors and hospitals, which could limit your options, especially if you live outside the plan’s service area.

2. No Network Restrictions
- With Original Medicare, you don’t have to worry about network restrictions. You can receive care from any provider who accepts Medicare, even if they are not in your area or part of a specific health plan's network.
- Medicare Advantage plans are usually HMO or PPO plans, meaning you must use network providers for in-network benefits, with exceptions or higher costs for out-of-network care.

3. Predictable Costs
- Original Medicare typically involves a monthly Part B premium, an annual deductible, and coinsurance for services. While the costs can add up, they tend to be more predictable, and many people supplement their coverage with a Medigap (Medicare Supplement) plan to help cover additional out-of-pocket costs.
- Medicare Advantage plans often have lower premiums but may require more out-of-pocket expenses in the form of copayments, coinsurance, and deductibles for specific services. These costs can vary significantly by plan and geographic area.

4. No Referral Requirements
- With Original Medicare, you do not need a referral to see a specialist. This is particularly advantageous for people with chronic conditions who need frequent specialist care.
- Medicare Advantage often requires referrals from a primary care doctor to see a specialist, which can be inconvenient for those who prefer direct access to specialists.

5. Nationwide Coverage
- Original Medicare offers nationwide coverage, meaning that you are covered for hospital and doctor services across the United States, including when traveling abroad in certain cases (for emergency care).
- Medicare Advantage plans typically offer coverage within a specific service area, and may not cover out-of-network or out-of-area care, especially for non-emergency situations.

6. Simplicity
- Original Medicare is straightforward: Part A covers hospital insurance, Part B covers medical insurance, and you can add a Medigap policy and a Part D prescription plan for additional coverage. This simplicity is appealing for people who don’t want to navigate the complexity of additional plan options and restrictions.
- Medicare Advantage plans often bundle multiple benefits (hospital, medical, and sometimes prescription drugs), which can be convenient but also more complicated due to varying plan structures, copayments, and coverage rules.

7. No Plan Changes Year-to-Year
- Original Medicare typically does not change from year to year. Once you’re enrolled, you continue with the same coverage unless you choose to make changes to your supplemental coverage or Part D plan.
- Medicare Advantage plans can change annually, with adjustments to premiums, coverage, and network providers. You may have to reassess your plan each year, which can be cumbersome.

Conclusion

While Medicare Advantage plans can offer additional benefits (such as vision, dental, and wellness programs), Original Medicare provides broader freedom, simplicity, and stability for many beneficiaries. The choice between the two will largely depend on your health needs, preferences for healthcare flexibility, and your budget for premiums and out-of-pocket expenses.