Medicare Advantage vs. Medigap: What to Know?

Many private insurers sell Medicare Advantage and Medigap policies, but a few significant distinctions still exist. Medigap is a supplement that fills the gaps by covering out-of-pocket expenditures associated with Original Medicare. In contrast, Medicare Advantage plans replace Original Medicare and typically give more coverage. You can purchase either one or the other, but you cannot have Medigap coverage and a Medicare Advantage plan. Let’s learn more about Medicare Medigap Los Angeles.

What is (MA) Medicare Medigap Los Angeles?

Medicare Advantage and Medicare supplemental insurance (Medigap) function is the most significant distinction.

Medigap is meant to make up for some gaps (also known as cost-sharing) left by Original Medicare, such as coinsurance, copayments, and deductibles. On the other hand, Original Medicare covers 80 percent of Medicare-covered services such as physicians' visits, outpatient medical treatments, and supplies.

Medicare Advantage programs replace Original Medicare. These plans, sold by commercial insurers, include everything that Original Medicare covers plus additional dental and eye care services, which traditional Medicare does not cover.

In certain situations, Medicare Advantage plans may limit your options for doctors and health care providers. For example, you may see any doctor or provider who accepts Medicare if you have Medigap. However, a Medicare Advantage plan does not allow you to get Medigap coverage. You might be able to swap between the two programs, though.

Most Significant Differences Between Medicare Advantage and Medigap

Doctors' Choice

• Medicare Advantage requires you to see providers who are part of the plan's network or pay a higher out-of-pocket cost.
• You can utilize any doctor or hospital that accepts Medicare if you have Medigap coverage.

Costs

• On top of your Medicare Part B payment, you'll pay an average of $19 per month for Medicare Advantage in 2022.
• In 2022, the average Medigap premium will be $1,956 per year ($163 per month).

Coverage

• Medicare Advantage provides coverage for Medicare Parts A and B and other services such as vision, dentistry, hearing, and prescription medicines.
• Medigap still has Original Medicare Parts A and B, as well as an array of Medigap plans to choose from, each with varying levels of coverage.

Limit on Out-of-Pocket Spending

• Medicare Advantage has Annual out-of-pocket payments limited to $7,550 for in-network treatments and $11,300 for in- and out-of-network services.
• If you're concerned about Medicare's limits, Medigap coverage can help. Each plan offers its own set of benefits and out-of-pocket payments.

Insurance for Prescription Drugs

• Prescription medication coverage may be included in Medicare Advantage plans.
• You can purchase Medicare Part D prescription medication coverage separately in Medigap.

Referrals

• To see a specialist under Medicare Advantage, you may need a recommendation from your primary care physician.
• Referrals from your primary care physician are not necessary for Medigap coverage.

Key Takeaways

• If you are in good health and have minor medical bills, Medicare Advantage is a cost-effective option. However, if you have a primary medical condition, Medigap is usually a better option.
• You can't have both Medicare Advantage and Medigap coverage. However, if your health-care costs alter, you can move between the two plans.
• Dental and eye care are included under Medicare Advantage. Medigap does not cover these services.

Simpler Horizons Insurance Solutions is a medicare Medigap agency in Los Angeles that will assist you in choosing the right medical plan for yourself. Simpler Horizons Insurance Solutions has insurance agents in Los Angeles that will explain which program will be the best for you. Visit our website for further information.