Medicare Advantage
vs Medigap

Medicare Advantage Plans

A Medicare Advantage plan is another way to receive Medicare benefits. These plans are known as “Part C”  or “MA Plans” and are offered by companies approved by Medicare. Most include prescription drug coverage (Part D).  Many include additional benefits such as: Dental coverage, Eye exams and glasses, Hearing exams and hearing aids, Gym memberships, Transportation.

 

Types of Medicare Advantage Plans (Part C)

Health Maintenance Organization (HMO) Plans

They have a Primary Care Physician who coordinates care, they typically pay only their network providers.

Point of Service (POS) Plans

The POS have the benefits of an HMO but with the option of seeing specialists without the need for a referral.

Preferred Provider Organization (PPO) Plans

PPO plans cover both in-network and out-of-network providers. They have less coverage outside the network.

Special Needs Plans (SNP)

- Special needs plans  dual eligibility (D-SNP) for people who have both Medicare and Medicaid.

- Chronic Special Needs Plans (C-SNP)  for people living with serious chronic conditions.

- Institutional Special Needs Plans (I-SNP)  for people who live in a skilled nursing facility.

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Why choose Medicare Advantage?

Doctors and hospitals:  You must use network hospitals and doctors.

Referrals:  You need referrals to network specialists and should use them for lower costs.

Prescription drug coverage:  Most plans include prescription drugs.

Costs:  A low monthly premium is paid many times $0. When you use the services you may have deductibles, copays or coinsurance. It has a maximum spending limit.

Inscription:  There are specific periods in which you can register (October 15 - 7  December)  or change (January 1  March 31st)  Medicare Advantage plan. You cannot be denied coverage or charged more because of your health condition.

Coverage when you travel:  Emergency care is covered for travel within the United States and sometimes abroad. Non-emergency care will depend on your plan's service area.

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Supplemental Insurance Plans (Medigap)

These plans help cover expenses that Medicare Part A (Hospital) and Part B (Medical) do not cover, such as:

• Deductibles

• copays

• Coinsurance

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Why choose Medigap?

Doctors and hospitals:  You can use any hospital or doctor that accepts Medicare.

Referrals:  You do not need a referral to see a specialist.

Prescription drug coverage:  Does not include prescription drug coverage. A Part D plan must be purchased.

Costs:  A monthly premium is paid that ranges between $100 and $300 per month, depending on the plan, region, gender, age, and tobacco use. For medical and hospital services, copays and coinsurance are minimal or zero. According to the chosen plan.

Inscription:  You can apply for a plan any time after your 65th birthday. If you apply within the first 6 months of your 65th birthday, coverage is guaranteed regardless of your health status.

Coverage when you travel:  Coverage is throughout the United States and, depending on the plan, may include emergency care abroad.