April 24, 2021

Thanks for continuing to send questions, I love helping you navigate through this maze of Medicare.

How do I determine wether I should go with a Medigap (also called a Medicare Supplemental plan) or if I should choose a Medicare Advantage plan?

Unfortunately there is not a one-size-fits-all approach to this question. I wish it was just a simple answer but this one can get complicated quickly and I wouldn’t suggest you try and go it alone. One of the things that makes this so personal to each individual is that it depends on how healthy you are, and how often do you go to the doctor? If you go to the doctor frequently then a Medigap plan may be the best solution for you, but that also begs the question of what is frequently. As you can already tell the two things that will dictate this answer are one in the same. How often you go to the doctor usually determines how healthy you may or may not be. Now one thing that we have yet to answer is what is frequent? To one person that answer may be that they go to the doctor 3 times a year and that is frequent to them, the next person may think that going to the doctor 12 times per year is not frequent. There is a method to the madness on how to figure out which is a better option for you. You may need to reach out to an agent that you can trust and that they are really looking to help you decide on the best plan for you personally.

When we look at Medigap verses Medicare Advantage, there is an easy and quick way to remember the main difference. Medigap is referred to as “pay as you know” in that you will always know what your expense will be for the year. Medicare Advantage is known as “pay as you go” in that you only pay when you use medical services. If you don’t frequent the doctor/specialists very often the Medicare Advantage plan may be a good option for you. If you are a frequent flyer to the doctor/specialist you may want to look into a Medigap plan.

Medigap plans have a monthly premium and you would also need to have part D prescription drug coverage as well which has a premium with it too. This is why this is called the “pay as you know” approach. Medigap plans are accepted by any doctor that accepts Medicare. Medicare Advantage plans with many companies have a $0 monthly premium and include your part D prescription drug coverage, which is why this is called the “pay as you go” approach. Advantage plans also come in both options of an HMO or a PPO. With many companies, this gives you a very large medical network of doctors to choose from. Medicare Advantage plans have a MOOP on them which stands for Maximum Out Of Pocket or a capped spending limit. Once the limit is reached all covered services are provided at no additional cost to the patient. I hear many people say that they don’t pay anything for their Medigap plan when they go to the doctor which is not true, they pre-paid it essentially with their monthly premiums whether they go to the doctor or not. However, the monthly premiums often exceed the maximum out of pocket cap placed on many Medicare Advantage plans.

Another big difference between the two plans is how they work with original Medicare. Medigap plans work alongside original Medicare’s Part A and Part B to help with out-of-pocket expenses, such as deductibles, coinsurance, and copayments. Medicare Advantage plans combine original Medicare’s parts A and B, and the majority include coverage for prescription drugs. Advantage plans often also include other benefits not available with original Medicare, including vision, dental, or hearing coverage and some plans offer out of the country benefits as well.

It is important for a person to examine all the differences carefully before making a decision. You should also make sure that your doctors and the hospital that you prefer are in network before you make your decision.

I hope that adds a little clarity to the question this week and if it created even more questions than answers I do apologize. Please don’t hesitate to reach out with your questions and if you don’t reach out to me please reach out to someone that will have your best interest at heart.

I look forward to your questions for next week, until then, stay safe and stay informed.
Nick Swearngin
Licensed Sales Representative