When it’s time to enroll in Medicare, many beneficiaries find themselves asking questions about Original Medicare, Medigap, and Medicare Advantage plans. While there are many ways to confront these questions, it is important to understand the difference between Original Medicare plus Medigap, and Medicare Advantage. Either of these options might work for you, but you cannot choose both.
Original Medicare (Parts A and B) is designed to cover a significant amount of your healthcare needs. However, beneficiaries are still responsible for the cost of premiums, co-pays, deductibles, and the cost of uncovered services.
Medicare Supplement Insurance, or Medigap policies, were designed to pay for some of the above uncovered expenses. They do not cover dental visits, vision care, long-term care, hearing aids, or private-duty nursing, but they do pay for co-pays, some types of co-insurance, and deductibles. Many Medigap policies also pay for many healthcare services received outside of the United States, such as when you get sick while traveling.
Medigap policies sold after 2006 do not include prescription drug coverage, so those enrolled in Original Medicare plus a Medigap policy might wish to enroll in Part D (prescription) coverage as well.
To sum up, Medigap serves as supplemental insurance to Original Medicare only. It helps to “close the gap” between covered and uncovered expenses, but does not guarantee you will never incur any out-of-pocket expenses at all.
Medicare Advantage plans are the alternative to Original Medicare. They combine both Parts A and B coverage, and often include prescription drug coverage as well.
Medigap plans don’t work with Advantage plans. However, if you find yourself dissatisfied with your Advantage plan, you can switch back to Original Medicare during Open Enrollment. Under federal law you have 12 months to add a Medigap policy to supplement your coverage.
Since the coverage limits between all of these plans can get confusing, work with an experienced Medicare insurance broker. We will help you analyze your specific needs and then work to match you with a plan that meets your preferences. And remember, you can always change your mind during Open Enrollment if you find yourself dissatisfied with a plan choice.