Original Medicare covers many medical services, but not everything. That’s why people can get additional coverage from a Medicare Supplement (Medigap) plan.
According to the American Association for Medicare Supplement Insurance, around 23% of beneficiaries use Medigap alongside basic Medicare.
However, many beneficiaries consider switching from Medigap to Medicare Advantage for cost savings or access to more benefits. To date, 48% of the eligible Medicare population is enrolled in a Medicare Advantage plan, based on data from the Kaiser Family Foundation.
If you’re considering switching from Medicare Supplement to Medicare Advantage, it’s essential to understand the differences between the two plans. Here are some commonly asked questions:
Why do You Need Additional Coverage?
Original Medicare pays for many medical services and supplies, but it doesn’t cover everything. For instance, Medicare Part A covers hospital stays, while Medicare Part B covers doctor visits and preventive care. However, both parts of the Original Medicare don’t cover long-term care or prescription drugs.
To fill in the gaps left by Original Medicare, you can get a Medigap plan or enroll in a Medicare Advantage plan. Both options offer additional coverage for services not covered by basic Medicare.
What is Medicare Supplement Insurance?
Medicare Supplement Insurance, also known as Medigap insurance, is a type of health insurance designed to supplement Original Medicare (Parts A and B). It helps cover some of the out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
These policies are offered by private companies approved by Medicare. They are standardized, so each policy offers the same basic benefits regardless of which company you choose. The main benefit is that it can help reduce your out-of-pocket costs when you need medical care covered under Part A or Part B.
What is Medicare Advantage?
Medicare Advantage is a type of health insurance offered by private companies and approved by the Centers for Medicare & Medicaid Services (CMS). These plans are an alternative to Original Medicare and provide all of the benefits covered under Part A and Part B of Original Medicare.
Most Medicare Advantage plans offer additional coverage such as vision, hearing, dental, prescription drugs and/or health services not covered by Original Medicare. Enrollees may also access extra benefits like gym memberships or meal delivery services.
In most cases, beneficiaries can choose their own doctors from within the plan’s network of providers. Premiums for Medicare Advantage plans may be lower than Medigap policies. However, enrollees usually have to pay copayments or coinsurance when they receive care.
Can You Switch From Medigap to Medicare Advantage?
Yes, it is possible to switch from Medigap to Medicare Advantage. However, Hellahealth explains that there are several things to consider before making the switch.
First, compare the benefits of your current Medigap policy and your potential Medicare Advantage plan. While the latter is initially more cost-effective, the former may provide better coverage for your medical costs.
Also, review the drug choices covered by your prospect plan. While the new plan can cover your prescription, it may require prior authorization. In this case, you need to make sure your physician can refer you to the specialists you need.
Finally, consider the network restrictions of your potential plan. It should cover all the providers you need, including specialists and hospitals in your area. If there are gaps in coverage, determine if they are acceptable for you.
Why Make the Switch to Medicare Advantage?
There are a few reasons why someone may want to switch from Medigap to Medicare Advantage.
Medicare Advantage plans typically offer more cost-effective coverage than Medigap. While Medigap plans provide comprehensive coverage, they usually come with higher premiums. Those who don’t need the full coverage of Medigap may benefit from the lower premiums offered by Medicare Advantage plans.
Second, Medicare Advantage plans come with additional benefits not available through Medigap. These include vision, dental, and hearing coverage, as well as prescription drug coverage and access to a wide range of providers.
Many Medicare Advantage plans offer various extra services, such as home health care or transportation assistance, that are unavailable under traditional Medicare or Medigap plans. This can help those who need extra support in managing their healthcare needs.
How to Switch From Medigap to Medicare Advantage?
Switching from Medigap to Medicare Advantage is a process that requires careful consideration and research. Here are some steps you should take to ensure the transition is successful:
- Research different Medicare Advantage plans in your area.
Start by researching the available plans in your area, including premiums, coverage levels, and out-of-pocket expenses. You can use online resources such as medicare.gov or speak with an insurance agent for more information about each plan’s benefits and costs.
- Make sure you qualify.
To be eligible for a MA plan, you must have both Part A (hospital coverage) and Part B (medical coverage) of Original Medicare.
- Make sure your doctor is in the plan’s network.
MA plans require you to use specific providers within their network to receive the most benefits. Check with your current healthcare provider to see if they are part of the new plan’s network before signing up.
- Enroll.
Once you have chosen a plan, prepare to contact the insurance company directly or through an agent to enroll. There is an Annual Enrollment Period from October 15 to December 7 each year, during which you can make changes to your MA plan.
- Cancel your Medigap plan.
Once enrolled in an MA plan, make sure to cancel your Medigap policy. This will ensure that you don’t incur additional costs with both plans.
Switching from Medigap to Medicare Advantage can be a complex process, but by taking the time to research and understand your options, you can make an informed decision that best fits your needs and budget.
Is Medicare Advantage Better Than Medigap?
There is no one-size-fits-all answer to this question, as it depends on each beneficiary’s individual medical needs and financial situation. Some people may find that Medicare Advantage plans offer better coverage than Medigap plans, while others may find the opposite to be true.
The best way to determine whether a Medicare Advantage plan is better for you than a Medigap plan is by comparing their features side by side. Compare benefits such as annual deductibles, out-of-pocket maximums, and prescription drug coverage between different Medicare Advantage plans in your area.
Also, factor in any premiums or copays associated with each plan. Medicare Advantage plans often have lower premiums than Medigap plans, but they may also require copays or coinsurance payments for certain services.
