What is the difference between Medicare Advantage and Medigap insurance?
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Asked September 10, 2012
When you apply for Medicare, you will be assigned to a Medigap or Medicare advantage plan according to the CMMS guidelines. You can think of Medigap as a PPO type of health plan, and Medicare Advantage as an HMO plan for comparison. If your doctor is a member of the Medicare Advantage plan, you have no need for Medigap, and vice versa.
Medigap, because of the PPO nature of the plan, offers you more flexibility in which doctors you see, but you should keep in mind that care you receive from a doctor outside of the network will result in your paying the difference in cost yourself. Unless you absolutely must go outside the network, the most affordable option is to limit your care to in-network services.
Medicare Advantage plans may provide limited coverage for prescriptions. If the coverage is not sufficient, you can also purchase a Medicare Part D plan, which is de3signed to assist in prescriptions and medical supply purchases. However, if you have the Medicare Advantage plan you will forfeit the coverage offered under Original Medicare.
For most patients, The HMO-type Medicare Advantage is more appropriate than Medigap coverage, because there are more out of pocket expenses associated with it than with the Medicare Advantage plan. You will never have both Medigap and Medicare Advantage coverage at the same time.
Medigap coverage is not as common as Medicare Advantage, and has limitations that Advantage does not. For most purposes, Medicare Advantage will be a better choice than Medigap coverage, and it is the one assigned to most Medicare applicants.
Answered September 10, 2012 by Anonymous