The Medicare health program being offered to people over the age of 65 can be very confusing for some, it is sometimes difficult to identify exactly what the original Medicare covers and many are left thinking if it is necessary for them to get a Medicare Advantage Plan and Medigap because they don’t know exactly what these are for.
A Medicare Advantage Plan offers the same coverage as your original Medicare but these are purchased from a private company instead. A Medigap covers some of the gaps or services that are not covered by original Medicare, acting as a supplement to it. Aside from this difference, there are many things that sets the two Medicare health plans apart.
Who is it for?
A Medicare Advantage Plan is a managed care plan which is perfect for those who are finding difficulty looking for a Medicare provider. Getting a packaged Medicare Advantage plan from a private company can simplify your choices and can help you save money if you do not come in for frequent treatments. Medigap plans will benefit those who needs frequent medical care and obtaining one may be the most economical option because it takes care of out of pocket expenses that your original Medicare does not cover.
Who is eligible?
Both plans require that members have both Parts A and B of the original Medicare. Anyone can apply and be approved for Medicare Advantage Plan except for those with End Stage Renal Disease, and even this can be approved with exceptions. A Medigap may have restrictions on approval depending on age and health conditions except for period of Guaranteed Issue and Medigap Open Enrollment.
The benefits for a Medicare Advantage Plan may change every year, however, you are guaranteed to remain enrolled unless you “disenroll” yourself during election period. Medigap, on the other hand, is renewable so long as you pay the premiums. Election season does not affect Medigap and the benefits remains the same every year.
Who provides for your care?
In Medicare Advantage Plans, the care is provided either by an HMO (Health Maintenance Organization), a PPO (Preferred Provider Organization), or PFFS (Private Fee for Service). These providers have set rules on how you can get the benefits and may require you to get referrals for specialist appointments. People who have a Medigap plan can go to any provider who accepts Medicare. There is no need to get referrals when you need to see a specialist.
What is the cost?
The premiums for Medicare Advantage Plans are the same for all members regardless of their gender, age, or health condition. These plans have a maximum annual out of pocket expense and there is cost sharing for most of the medical services. With Medigap, the cost of the premiums depends on the member’s age and medical condition. However, even if the premiums may be higher, there are no copay costs during the time that the service is received and there is no out of pocket maximum stated.