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.
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.
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.
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.
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:
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.
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.
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
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.