Differences Between Medicare Advantage Vs Medigap plans?
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. Discover all differences between HMO vs PPO.
The 2024 chart below shows you several differences between Medicare Advantage vs Medicare Supplement.
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.
Medicare Advantage charges you copays for each doctor visit or medical service. However, MA Plans do not charge you coinsurance.
Medicare Supplement plans have no copays, except plans K (50%), L (75%), and N.
Medicare may charge copays for diagnostic tests, hospital outpatient, and ER visits. For Plan N, you pay up to $50 for each outpatient emergency room visit and up to $20 for each outpatient doctor visit.
Furthermore, Supplement Plans K and L only pay 50% and 75% respectively for Part B,
Part A Hospice, and Skilled Nursing Facility coinsurance. In other words, you pay the remaining balance. For example, Medigap Plan K will cover 50% of your outpatient Medicare service.
Part B Premium
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.
Copays and coinsurance
Medicare Advantage charges you copays for each doctor visit or medical service. However, MA Plans do not charge you coinsurance.
Medicare Supplement plans have no copays, except plans K (50%), L (75%), and N.
Medicare may charge copays for diagnostic tests, hospital outpatient, and ER visits. For Plan N, you pay up to $50 for each outpatient emergency room visit and up to $20 for each outpatient doctor visit.
Furthermore, Supplement Plans K and L only pay 50% and 75% respectively for Part B,
Part A Hospice, and Skilled Nursing Facility coinsurance. In other words, you pay the remaining balance. For example, Medigap Plan K will cover 50% of your outpatient Medicare service.
Advantage Vs Supplement Plan Premiums
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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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 2024 is $8,850. 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 2024 limits on plans K and L.
$7,060 for Plan K ($120 increase from 2023)
$3,530 for Plan L ($60 increase from 2023)
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