What are my coverage choices MAPD – Medicare Advantage vs Original for Medicare Coverage?

Which is better, Medi Gap-Supplemental or Medicare Advantage?

Medicare Choices - from Medicare & You
Medicare Choices – from Medicare & You

Check out the video below and/or see Medicare & You # 10050 Page4 et seq, from Medicare to learn more about your choices of how to get coverage and any coverage to pay for what Medicare doesn’t cover when you first enroll or if you already have Medicare.

The three main options:

  • Medi-Gap – Supplemental – Basically pays the Part A Hospitalization Deductibles and 20% Doctor Visits that Medicare doesn’t pay.  Doesn’t include Prescriptions.  Plans F & G start around $150/mth.  Hi F with a $2k deductible for what the Insurance Company pays, NOT Medicare starts around $61/month.  ANY doctor, provider or hospital that takes Medicare!
  • Rx Prescription Drugs PDP – practically mandatory coverage, as there is a penalty if you don’t buy it, imposed when you eventually do purchase Rx coverage.  Premiums start around $25/month.
  • Medicare Advantage – MAPD   –  Generally very low or no premium, HMO coverage, choose providers from the Insurance Companies authorized list  and includes “PD” Prescription Drug coverage.

Three things to consider before choosing which one to get:

Cost: 

Medigap coverage usually has a higher monthly premium, but could result in lower out-of-pocket expenses than some Medicare Advantage plans. Medicare Advantage plans, on the other hand, generally cost less and cover more services, which can be the better option for your budget.

Choice:

Medicare Advantage plans generally limit you to the doctors and facilities within the HMO or PPO, and may or may not cover any out-of-network care. Traditional Medicare and Medigap policies cover you if you go to any doctor or facility that accepts Medicare. If you require particular specialists or hospitals, check whether they are covered by the plan you select.

Lifestyle:

Medicare Advantage plans often only operate with a certain region. If you’re a snowbird living in more than one state throughout the year, traditional Medicare plus Medigap is probably a better choice than an Advantage plan. This may also be true if you travel frequently: Some Medigap plans provide coverage when traveling outside of the United States and cover you in all 50 states; Advantage plans generally do not.  Read more: Investopedia

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Things to consider - which Medicare Options?

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Introduction to Medicare Advantage

More flexibility with your treatment options

With Original Medicare you don’t have to choose a Primary Care Physician (a requirement of some Medicare Advantage plans), so you don’t have a “gatekeeper” who has the final say on which providers you see. You can shop around for the care and treatment that you want. You can also choose to see any physician who accepts Medicare. On the other hand, MA plans are more restricted in terms of the provider networks they work with. Individuals in rural and isolated areas may have difficulty finding MA plans that work with their local healthcare services.

Additionally, it’s important to remember that if you choose an MA plan initially, and then try to switch to a Medigap policy after a year has gone by, you may not be able to. Signing up for a Medigap policy initially gives you some time to see how your health situation is developing. After a few years with no major medical problems, you may feel more comfortable switching to a Medicare Advantage plan.

Medigap policies can be easier to understand

Perhaps “easy” isn’t the best term, but with Medigap there are 10 types of policies that all pay for the same things–which makes comparing costs relatively simple. These 10 categories are used all over the country, so you can also make decisions about what your costs might be if you move. The same is not true of MA plans, which differ by state and often go by totally different names depending on where you live.

What are some of the disadvantages of choosing
Original Medicare combined with a Medigap policy (versus Medicare Advantage)?

More expensive

Medigap plans can be two to three times the cost of an MA plan.

More systems to keep track of

With Original Medicare, a Part D drug plan, and Medigap you have three cards to keep track of and two monthly bills to worry about. For those who feel that they are already burdened by too many monthly bills and pieces of paper, this just adds to the pile.

More decisions to make

Sometimes choices can be a burden. MA plans are supposed to navigate the system for you to contain costs and increase communication. Many people value having a Primary Care Physician (common with many MA plans) to take charge of some of the decisions and find the appropriate specialists.

To get drug coverage, you’ll need to choose a Part D plan

For some beneficiaries, trying to find the right Part D plan is about as fun as a root canal. An MA plan takes care of that for you by including drug coverage already. If you go with an MA plan, remember to make sure that whatever MA plan you choose will cover your existing prescriptions at an affordable price. my medicare matters.org

Medi Gap vs Medicare Advantage from Medicare Rights.org
Medi Gap vs Medicare Advantage from Medicare Rights.org

Five Questions from Medicare.Gov to help you decide on Medicare Advantage or Medi Gap?

5 questions to deceide on Medicare Advantage or Medi Gap

15 comments on “Original Medicare & Medi-Gap – Supplement vs Medicare Advantage MAPD

  1. I am confused with so many different parts. We have part A, B, D and medi gap. What else is there?

    • Part A is Hospital Coverage and normally US Citizens who have worked here don’t have to pay any premium. There are deductibles and limits if you are in the hospital a long time.

      Part B is out of hospital – doctor visits the premium starts at $135/month, more if you make a lot of $$$ Part B leaves 20% for you to pay and doesn’t cover outside the USA.

      Part C is Medicare Advantage – an HMO… that would cover the gaps in Parts A & B, it also includes Part D Rx

      Part D Rx Prescriptions Covers your prescriptions. If you get a Medicare Advantage Plan – HMO then it’s included. Otherwise it runs $30 to $100/month

      Medi Gap or Supplemental covers the gaps in Parts A & B. Part D is a separate coverage. Medi Gap allows you to go to ANY MD that accepts Medicare! https://www.medicare.gov/physiciancompare/

      To expand on your question of what else is there?

      Medicare does not cover Long Term Care (Skilled Nursing is very limited) or Life Insurance

    • In reply to confused anonymous.

      Sorry to hear that you got confused because of many Medicare parts. Well, you are not alone. Most people who are new to Medicare get confused also. On the other hand, what we call Original Medicare, (Medicare) has different PARTS which provide coverage each in different ways.

      See the reply above

      There is also Part C or Medicare Advantage plans which are sold by private health insurance companies. This kind of plan takes the place of your Medicare Part A and Part B and provides all the benefits of both parts plus additional benefits (prescription coverage, vision care, dental care, etc.). There are out-of-pocket expenses that you still have to shoulder in this option.

      Medigap or Medicare Supplement plan is an option that works WITH Medicare, hence you need to have Medicare Part A and Part B. Depending on the type of Medigap plan, it will cover all or part of out-of-pocket costs from Original Medicare (deductibles, copays, coinsurance). It pays AFTER Medicare paid its share. It has ten standardized plans which you should not confuse with the names of the Parts of Medicare. You may have to get Part D to have drug coverage because prescription coverage is not included in its benefits.

  2. I’m not happy with my MAPD program. What do I have to do to get a Medi Gap – Supplement Plan?

  3. my present plan is Medicare Advantage. Other than the word, does Medicare pay for my policy/plan?

    How does my Blue Cross MAPD PPO coverage differ amongst Medicare plans?

    Is my Medicare Advantage considered a medi blue or medpay or pip?

  4. My main question was about Medicare Advantage over an independent Medicare supplement/ Medi Gap prescription plan Part D:

    Is Medicare Advantage an HMO where I have to go thru a primary doctor to see a specialist?

    • Yes, most all Medicare Advantage Plans are HMO and you must go to a PCP Primary Care Physician first. There are very few PPO’s in MAPD. Those pay very little if you go out of network. Check the actual EOC Evidence of Coverage for details.

      One big advantage of Medicare Advantage is they are generally zero premium. You just have to pay your Part B Medicare and they include Part D Rx.

  5. Is there a difference between medigap and medicare supplement plans.

    In Texas we had a choice between advantage and supplement plans, but the titles here seem to be different.

    Has something changed?

    • Medi-Gap and Medicare Supplement are used interchangeably, they are the same thing. They pay in addition to Medicare A & B, any MD that accepts Medicare, which is most all providers, no HMO list. Provider Finder. See our related pages section above for links to Blue Cross and Blue Shield Medi-Gap plans and the premiums. Medicare Advantage has a plus going for it, in that the premiums are often zero.

    • No. While AETNA is a fine company, even if they did pull out of CA for under 65, we can’t be all things for all insurance companies. We feel we can give you the best service, knowledge, etc. by representing Blue Cross, Shield and AARP.

      If you are dead set on Aetna, you can click here, get quotes, enroll and we get a finders fee, but won’t be your agent.

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