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What is the difference between Medicare Advantage and Medigap?

The short answer

Medicare Advantage replaces Original Medicare with one private plan that usually has a network, copays and a yearly out-of-pocket limit. Medigap, also called Medicare Supplement, works alongside Original Medicare and helps pay your share of costs. You cannot use both at the same time.

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Reviewed by the licensed agents at Health Insurance Solutions in Orlando, Florida.

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How does Medicare Advantage work?

You still have Medicare, but a private insurer runs your coverage. Plans must cover everything Original Medicare covers, and many add drug coverage, dental, vision or hearing. Most use a network of doctors and hospitals, and you pay copays or coinsurance when you get care. Every plan has a yearly limit on what you pay out of pocket for covered services.

How does Medigap work?

You keep Original Medicare and buy a separate Medigap policy to help with costs such as deductibles, copays and coinsurance. Standard plans are labeled with letters, and a given letter covers the same benefits no matter which company sells it. Medigap does not include drug coverage, so most people add a separate Part D plan. You can usually see any doctor who accepts Medicare.

How do they compare?

What to compareMedicare AdvantageMedigap
Monthly costOften a low or no extra premium.Higher premiums, but costs at the doctor are lower and more predictable.
Choice of doctorsUsually has a network.Works with any provider that accepts Medicare.
Drug coverageMany plans include it.Does not include it.

Switching later: in most states, insurers can ask health questions if you move to a Medigap plan after your first six months. Our state pages explain each state's rules.

How do I decide?

Start with your doctors, your prescriptions and how much you travel. Check that your doctors take the plan you are considering. A licensed agent can compare the Medicare plans we offer and explain the tradeoffs at no cost to you. We do not offer every plan in every area, and you can always compare options at Medicare.gov or 1-800-MEDICARE.

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Enter a birth date to see when your seven-month Initial Enrollment Period starts and ends.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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Common questions

Can I have Medicare Advantage and Medigap together?

No. Medigap does not work with Medicare Advantage, and it is against the rules for a company to sell you Medigap if you have a Medicare Advantage plan.

Does Medigap cover prescription drugs?

No. Most people with Medigap add a separate Part D drug plan.

When is the best time to buy Medigap?

Your Medigap open enrollment period starts when you are 65 or older and enrolled in Medicare Part B. For six months, insurers cannot turn you down or charge more because of your health.

Sources

Rules change. Confirm dates and eligibility with your marketplace, your state Medicaid agency or Medicare before you enroll.

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