What is the Difference Between Medicare Advantage and Medicare Supplement Plan or Medigap Plan G?

Medicare Advantage and Medigap Plan G are two options for Medicare beneficiaries looking to supplement their Original Medicare coverage. With Medicare Advantage, you enroll in private health insurance plans approved by Medicare that provide all of your Part A and Part B benefits. Plan G is a Medigap policy sold by private insurance companies that helps pay for costs left over after Original Medicare pays its share. Understanding the key differences between these two plans can help you choose the right supplemental coverage.

Medicare Advantage Plan

Medicare Advantage, also known as Medicare Part C, allows you to receive your Medicare benefits through private insurers approved by Medicare. Medicare Advantage Plans may cover everything that traditional Medicare covers, but many offer additional benefits like vision, hearing, dental, and prescription drug coverage. Medicare Advantage Plans type of plan often have lower premiums than Original Medicare plus Medicare Supplement insurance or Medigap policy. However, provider networks and service areas are limited.

There are different types of Medicare Advantage Plans including:

• HMO: Health Maintenance Organizations provide care from a network. Referrals are required for specialists.

• PPO: Preferred Provider Organizations allow more flexibility to see out-of-network providers for a higher cost.

• PFFS: Private Fee-For-Service plans allow you to see any Medicare provider as long as they accept the plan's payment terms.

• SNP: Special Needs Plans are designed for specific populations like those with chronic illnesses.

III. Medicare Supplement Plan G

Medigap Plan G is one of 10 standardized Medigap policies sold by private insurance companies to help fill coverage gaps in Original Medicare. Here's what Plan G covers:

• Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up

• Medicare Part B coinsurance or copayment

• First 3 pints of blood per year

• Part A hospice care coinsurance or copayment

• Skilled nursing facility care coinsurance

• Part A and B deductibles

• Part B excess charges

• Foreign travel emergency care (up to plan limits)

IV. Differences between Medicare Advantage and Medigap Plan Plan G

There are several key differences between Medicare Advantage and Medigap Plan G:

• Coverage - Medicare Advantage Plans replace Original Medicare, while Plan G supplements it.

• Costs - Medicare Advantage often has lower premiums, but can have copays and deductibles. Plan G has higher premiums.

• Providers - Medicare Advantage has network restrictions while Plan G allows you to see any provider who accepts Medicare.

• Prescription Drugs - Most Medicare Advantage Plans include Part D drug coverage. Plan G does not cover prescriptions.

• Travel - Plan G provides foreign travel emergency care. Medicare Advantage only covers emergencies within the U.S.

V. Medicare Plans Cost Comparison

Medicare Advantage Plans often have $0 premiums or low monthly premiums compared to Medigap policies. However, with Medicare Advantage you may still pay deductibles, copays or coinsurance depending on the plan. Plan G has higher premiums, but covers more out-of-pocket costs. Weigh the total costs when choosing coverage.

VI. Pros and Cons of Medicare Advantage and Plan G

Medicare Advantage Pros

• Lower premiums

• Extra benefits like vision and dental

• Part D drug coverage included

Medicare Advantage Cons

• Network restrictions

• Referrals needed for specialists

• Prior authorizations for services

Plan G Pros

• Freedom to choose any Medicare provider

• Low out-of-pocket costs

• Travel coverage

Plan G Cons

• Higher premiums

• No drug coverage

• Can't combine with Medicare Advantage

VII. Who Should Choose Medicare Advantage?

Those who may benefit most from a Medicare Advantage Plan include:

• Those wanting lower premiums and don't mind networks

• People with chronic conditions who qualify for Special Needs Plans

• Those who travel within the U.S. only

VIII. Who Should Choose Plan G?

Those who may benefit most from Plan G include:

• People who want broad provider choice and network flexibility

• Frequent travelers who want foreign travel emergency coverage

• Those looking for comprehensive supplemental coverage

IX. How to Switch from Medicare Advantage to Original Medicare Coverage?

You can leave a Medicare Advantage Plan and switch back to Original Medicare during the Annual Enrollment Period from October 15 to December 7 each year. Your coverage will start on January 1 of the next year. You can also switch to Original Medicare from January 1 to February 14. Your coverage starts the first of the month after the plan gets your request.

When you switch back to Original Medicare, you'll be able to add a stand-alone Part D prescription drug plan and a Medigap policy - but you may need to pass underwriting if it's your first time purchasing a Medigap policy. Keep this in mind when evaluating your options.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Bourgeois Insurance a Call at (985) 803-8999. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.

FAQs

What is a Medigap Plan G?

 Plan G is one of the most popular Medigap Plans. It covers Medicare Part A and B coinsurance and copays except the Part B deductible.

What is the difference between Medicare Advantage and Medigap Plans?

 Advantage Plans replace Original Medicare, while Supplement Plans like Medigap Plan G fill coverage gaps left by Parts A and B.

When can I enroll in Medicare Part B?

The initial enrollment period is the 7 months surrounding your 65th birthday - you must enroll unless you have qualifying health coverage.

What types of Medicare Advantage Plans exist?

Main types are HMOs, PPOs, Private Fee-For-Service Plans and Special Needs Plans. Coverage and networks vary significantly between plan options.

What services does Original Medicare cover?

 Parts A and B cover items like hospital stays, doctors' visits, preventive care, and some medical equipment and supplies.

How do I choose the best Medicare Plan?

 Consider your coverage needs, budget and providers. Seek advice from unbiased sources as every person's situation is unique.

When is Medicare Open Enrollment?

 Open Enrollment runs from October 15 - December 7 each year for coverage effective the following January 1.

What is Medicare Part D prescription drug coverage?

 Part D provides drug coverage that is acquired separately or bundled into a Medicare Advantage Plan. Stand-alone PDPs and MA-PDs offer this.

When can I switch Medicare Advantage Plans?

 During the Open Enrollment Period each fall, you may join another MA plan for the following year.

What information is provided during Open Enrollment?

 Annual Notices of Change from existing plans and information packets from CMS help beneficiaries evaluate plan options.

How do I use the Medicare Plan Finder tool?

 Medicare.gov/plan-compare allows customized searches comparing coverage/costs of Medigap, Medicare Advantage and Part D Plans in your area.

How do I enroll in or change a Medicare Part D Plan?

Contact the specific Part D Plan directly to complete enrollment once you've selected a PDP to coordinate new coverage start dates.