Medicare Advantage and Medicare Supplement are two very different ways to manage your Medicare coverage and out-of-pocket costs.
A Medicare Advantage plan is a private alternative for receiving your Medicare Part A and Part B benefits.
A Medicare Supplement, also called Medigap, works with Original Medicare and helps pay some of the costs Original Medicare leaves behind.
You generally choose one path or the other—you don’t use Medigap to pay Medicare Advantage expenses.
With Medicare Supplement:
Original Medicare pays first → Medigap pays according to your plan
With Medicare Advantage:
The private Medicare Advantage plan administers your Medicare-covered benefits
That’s a fundamentally different structure.
Provider Access
Medicare Supplement
Because Medigap works with Original Medicare, you can generally use healthcare providers nationwide who accept Medicare.
Medicare Advantage
Your access may depend on the plan’s provider network.
HMOs generally require you to stay in network except for certain emergencies and other limited situations.
PPOs generally allow out-of-network care, but you may pay more.
Prior Authorization
Original Medicare generally doesn’t require prior authorization for most services.
Medicare Advantage plans may require prior approval before certain services or supplies are covered.
Out-of-Pocket Costs
With a comprehensive Medigap policy, much of Original Medicare’s cost sharing can be reduced substantially.
With Medicare Advantage, you’ll generally have plan-specific copays, coinsurance and an annual out-of-pocket maximum for covered Part A and Part B services.
Premiums
Medicare Advantage plans may have low or even $0 additional plan premiums.
Medigap generally requires a separate monthly premium.
But don’t compare only premiums.
Compare:
Premium + deductible + copays + coinsurance + maximum exposure
Medicare Advantage vs. Medicare Supplement
This is one of the most important Medicare decisions you’ll make.
Medicare Advantage often wins the premium comparison.
Medicare Supplement often wins the predictability and provider-access comparison.
Neither one should be chosen based on a television commercial or one benefit.
I want someone looking at:
Doctors and hospitals
Travel
Prescription drugs
Prior authorization
Annual healthcare risk
Monthly premium
and perhaps most importantly:
What happens if your health changes later?
Medicare Advantage plans cover Medicare-covered cancer treatment, including qualifying chemotherapy, but plan networks, prior authorization rules and out-of-pocket costs can become especially important when someone has cancer.
Medicare’s Annual Enrollment Period, also commonly called Medicare Open Enrollment, runs, October 15 through December 7 each year.
Medicare on Video can help you compare the Medicare options we offer.
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