Even though Medicare.gov offers many pages of explanations, it can be hard to understand the details. However, the basics of the program are easy to understand once you dive into the details. Medicare offers Parts A (hospital care), B (doctors, medical procedures, equipment), and D (prescription drugs) provide basic coverage for Americans 65 and older. But there is Part C (Medicare Advantage Health Plan), which covers which covers relevant parts such as such as deductibles, co-pays, and other medical expenses that could wipe out your savings should you become seriously ill. Medicare Advantage Health Plan is one of two parts that protects you against the potentially high costs of an accident of illness. The second option is Medicare Supplement Insurance which is also known as Medigap coverage.

Medicare Supplement Insurance (Medigap)

This option is a private insurance policy that protects people who buy traditional Medicare against many of the additional costs a patient might pay in exchange for a premium charge in addition to what you would normally pay for Medicare parts A, B and D. Medigap plans (categorized from parts A to N) are standardized by Medicare. The Medigap policies cover you whenever you see any doctor or facility that takes Medicare.

Advantages

  1. Paying premiums on time means that you won’t be cancelled because of any health conditions or because of age.
  2. Prescription drugs co-payment.
  3. Coverage for vision and hearing services.
  4. Lower costs with the ability to choose your own services and providers.
  5. Coverage for services and facilities while traveling.

Medicare Advantage Health Plan (Part C)

This option provides more help at a lower cost than traditional Medicare plus Medigap. With Medicare Advantage Health Plan, you would enroll through a private insurance company that covers everything provided by parts A, B, and D. This means that services such as office visits, lab work, surgery, and many others are covered after a small co-payment charge.

Advantages

  1. Coverage for routine vision care, hearing aids, routine dental care, prescription drug coverage, and fitness center membership.
  1. Limit for out-of-pocket charges which means that once you have hit the limit, you pay nothing for covered medical services for the remainder of the year.
  2. Coordinates care among your healthcare providers.
  3. Medicare Part C is a “one-stop” center for all your health and prescription drug coverage needs.

Key Differences

Please note that it is illegal for an insurance to sell you a Medicare Advantage Health Plan AND a Medigap policy. Here are some key differences to help you make a better choice between the two.

Differences in:

Medicare Advantage Health Plan (Part C)

Medicare Supplement Insurance (Medigap)

Cost

  • Generally less costs.
  • Covers more services.
  • Higher monthly premium with lower out-of-pocket expenses.

Choice

  • Limiting to doctors and facilities within the Health Maintenance Organization (HMO) which has lower monthly premiums and lower cost-sharing plans with fewer network restrictions; or within the Preferred Provider Organization (PPO) which has higher monthly premiums and higher cost sharing plans.
  • May or may not cover out-of-network care.
  • Covers you if you go to any doctor or facility that takes Medicare.

Lifestyle

  • Only operates within a certain region.
  • Provides coverage when you are travelling outside the United States.
  • Covers you in all 50 States.
Attention!

Starting mid-August, you will likely begin to receive notices regarding changes in your Medicare coverage.
Please, do not wait until October 15th when Open Enrollment begins. Reach out as soon as you're able and have all your Medicare and AEP questions answered!