Key takeaways

  • Medicare Advantage (Part C) plans offer comprehensive coverage, often including vision, dental, and prescription drugs, through Medicare-approved private insurance companies.
  • Medigap plans help cover out-of-pocket costs associated with Original Medicare (parts A and B), such as copays, coinsurance, and deductibles.
  • Choosing between Medicare Advantage and Medigap depends on individual healthcare needs, budget, and preferences, as you cannot have both types of plans simultaneously.

While Original Medicare (parts A and B) covers your basic hospital and outpatient medical needs, there are certain things it does not cover.

Medicare Advantage (Part C) and Medicare Supplement (Medigap) plans are both designed to provide coverage that other parts of Medicare may not offer.

However, you may not purchase both Medicare Advantage and Medigap. You can only purchase a Medigap plan if you have Original Medicare.

Medicare Advantage (Part C) plans are an alternative option to Original Medicare (parts A and B). These plans are provided by Medicare-approved private insurance companies.

Medicare Advantage coverage

Medicare Advantage plans must cover the same things that Original Medicare does, including:

  • inpatient hospital care
  • outpatient medical services
  • hospice care
  • skilled nursing facility care
  • preventive care

Many Medicare Advantage plans also include prescription drug (Part D) coverage. People with Original Medicare must purchase a standalone Part D plan from a Medicare-approved private insurance company.

Depending on the Medicare Advantage plan you choose, your plan may also cover:

Costs

Medicare Advantage premiums vary depending on the provider and the plan you choose. Some plans may not require a monthly premium.

Out-of-pocket costs like copays and deductibles also vary by plan. You can compare plan costs in your area using the Medicare plan finder tool.

Other factors that may affect the cost of Medicare Advantage plans include:

  • how often you access medical services that require a copay
  • where you receive medical care (in-network or out-of-network)
  • your income
  • if you have financial assistance like Medicaid or disability benefits

Eligibility

To be eligible for Medicare Advantage:

  • You must be enrolled in Medicare Parts A and B
  • You must live in the service area of a Medicare Advantage insurance provider that offers the plan you want and that’s accepting new users during your enrollment period
  • You must be a United States citizen or lawfully living in the U.S.

Medigap plans are optional supplemental insurance products that help pay for some of the costs associated with Original Medicare.

Coverage

Medigap has various plans that help cover out-of-pocket costs not covered by your Original Medicare plan. Each plan may offer different coverage, but may include:

There are currently 10 different Medigap plans available: A, B, C, D, F, G, K, L, M, and N.

As of January 1, 2020, newly purchased Medigap plans don’t cover Part B deductibles. This means you cannot purchase Plan C or Plan F if you became eligible for Medicare in 2020 or after.

You can purchase Medigap in addition to your Original Medicare coverage.

Costs

Each insurance plan varies in price based on your eligibility and the type of coverage you choose.

With Medicare Supplement plans, the more coverage you want, the higher the cost. Additionally, the older you are when you enroll, the higher the premium you may have to pay.

Factors that may affect the cost of your Medigap coverage include:

  • your age
  • the plan you choose
  • whether you qualify for a discount
  • your deductible
  • when you purchased your plan
»Learn more: Medigap costs

Eligibility

You’re eligible to apply for a Medicare plan and add a Medigap policy during the 3 months before, 3 months after, and the month of your 65th birthday.

Insurance companies aren’t required to sell you a Medigap policy, especially if you’re under age 65.

Once the initial enrollment period and open enrollment period have passed, you may have a harder time finding an insurance company that will sell you a plan. As soon as you enroll in Medicare Part B, you should apply for a Medigap policy if you’d like one.

The following charts show some of the pros and cons of both Medicare Advantage (Part C) and Medigap plans.

Medicare Advantage may be a good fit for you if:

  • You already have parts A and B.
  • You have an approved provider you already like, and you know they accept Medicare and Medicare Advantage plans.
  • You want additional covered benefits, like hearing, vision, and dental.
  • You’d rather manage one plan for all of your insurance needs.

Medicare Advantage may not be a good fit for you if:

  • You travel extensively or plan to while on Medicare. (You must live within your plan’s coverage area, except for emergencies.)
  • You want to keep the same provider each year. (The requirements for approved providers change annually.)
  • You want to keep the same rate. (Rates change annually.)
  • You’re concerned about paying for extra coverage you won’t use.

Medigap coverage may be a good fit for you if:

  • You prefer to choose the amount of coverage for out-of-pocket expenses you’re purchasing.
  • You need help covering out-of-pocket expenses.
  • You already have the coverage you need for vision, dental, or hearing.
  • You plan on traveling outside of the United States and want to be prepared.

Medigap coverage may not be a good fit for you if:

  • You already have a Medicare Advantage plan. (It’s illegal for a company to sell you Medigap when you already have Medicare Advantage.)
  • You want coverage for extended long-term or hospice care.
  • You don’t use much healthcare and don’t usually meet your annual deductible.

There are many different plan options if you want additional Medicare coverage.

Medicare Advantage covers your Part A, B, and often D plans and more. Medigap helps pay out-of-pocket costs associated with Original Medicare (parts A and B) like copays and coinsurance.

You can’t purchase both of these types of plans, so it’s important to consider your needs and choose the option that best meets them.