A Medigap plan (PDF, 495.23 KB) is different from a Medicare Advantage plan. Medicare Advantage plans are a way to get Medicare benefits, while a Medigap only supplements your Original Medicare benefits.
| Medigap plans | Medicare Advantage plans |
|---|---|---|
Premium costs | Higher premiums | Lower premiums |
Out-of-pocket costs | Fewer out-of-pocket costs | More out-of-pocket costs |
Where you can get care | Works in any state | Works only in your state, by region |
Provider network | Don't need a provider network (unless you buy a Medigap Select plan) | Must use a provider network |
Prescription drugs (Part D) | Medicare Part D not included | Medicare Part D usually included |
What to consider before you buy a Medigap
- You must have both Medicare Parts A and B.
- You pay the private insurance company a monthly premium for your Medigap plan in addition to the monthly Part B premium you pay to Medicare.
- A Medigap plan only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
- If you buy a Medigap plan from any insurance company, it must be licensed in your state.
- Any standardized Medigap plan is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap plan as long as you pay the premium.
- If you’re NOT applying during the first six months, starting with the day you turn age 65 or older and you’re enrolled in BOTH Medicare Parts A and B, depending on the situation, insurers may require you to pass a written health screen.
What to consider before you buy a Medicare Advantage plan
- Check with your medical providers to see if they’ll accept the plan. Some providers may not accept all plans available in your county and some plans may require referrals to see a specialist.
- If you have Medicaid, check if your providers accept both the MA plan and Medicaid.
- Find out the plan’s monthly premium and copayments for various services, such as out-of-pocket limits, and the cost to use non-network providers.
- If the plan offers additional benefits such as dental and eye exams, find out if there will be additional premiums, or if it has limits on which providers you can use, or if it requires you to meet specific health criteria.
- If you live in another state part of the year, check with the MA plan if it requires you to use regular services within the service area (except for emergency care). This is usually the Washington state county you live in. Some plans do offer travel coverage, but you need to ask.
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