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Medigap Plans vs. Medicare Advantage Plans

The difference between Medigap and Medicare Advantage plans is in the type of coverage you’ll get. Learn more here.

By Clover Health

When it comes to Medicare, you have many coverage options. For example, you could enroll in Original Medicare and add a Part D plan to cover the cost of your medications. You could even enroll in a Medigap plan on top of your Original Medicare to lower your out-of-pocket costs. Or you could enroll in a Medicare Advantage plan, which may offer more comprehensive benefits at a lower cost.

We understand that these coverage options can be confusing. Let’s compare Medigap vs. Medicare Advantage plans so you can make the right decision about your Medicare coverage.

Medigap vs. Medicare Advantage

Both Medigap and Medicare Advantage plans are offered by private insurance companies, and they’re both designed to cover individuals.

The difference between Medigap and Medicare Advantage plans is the type of coverage you’ll get. Medigap, or Medicare Supplemental Insurance, plans help you fill in any “gaps” in your Original Medicare coverage.

For example, Original Medicare doesn’t cover most prescription drugs that people take at home. And coverage for services such as treatment at a skilled nursing facility may run out before a patient’s need for care does. A Medigap plan covers some of the costs where Original Medicare falls short, including copays, coinsurance, and deductibles but most Medigap plans don’t give you any additional benefits. 

Medicare Advantage plans are an alternative to Original Medicare that provides all the same coverage as Original Medicare and then some. A Medicare Advantage plan is a standalone plan that offers comprehensive healthcare coverage and lots of extra benefits. And unlike Original Medicare, Medicare Advantage plans have an annual limit on Maximum out-of-pocket costs/MOOP (costs paid by the member).

What Does Medigap Cover?

Medigap plans from private insurance companies help you fill in the gaps in your Original Medicare coverage. For example, each time you access a healthcare service, your Original Medicare plan (Part B) covers 80% of the cost. What about the other 20% of the cost? That’s where a Medigap plan can help. Medigap plans come with a monthly premium in addition to your Original Medicare premium(s), but they also help cover extra costs, making it easier to access healthcare. However, most Medigap plans don’t cover any additional services beyond those offered by Original Medicare.

What Does Medicare Advantage Cover?

Medicare Advantage plans cover your healthcare needs in one plan. Medicare Advantage plans generally have lower premiums than Medigap plans and offer more benefits. You won’t need to worry about multiple monthly premiums paid to all your Medicare plans. Medicare Advantage plans must include all the benefits of Original Medicare (Part A and Part B) and typically include added benefits, such as:
    •    Prescription drug coverage

    •    Additional benefits like hearing, dental, and vision
    •    Fitness memberships


Should You Switch from Medigap to Medicare Advantage?

If you’re satisfied with Original Medicare coverage, a Medigap plan can be a good option. It pays for copays and some out-of-pocket costs to lower your Original Medicare costs. However, Medigap plans don’t cover any Part D costs, and Medigap plans usually have high monthly premiums.

If you need more comprehensive coverage or your healthcare needs change, you may want to consider a Medicare Advantage plan. You’ll get more benefits and usually pay lower monthly premiums. However, you may need to pay copays and out-of-pocket costs.

Switching from Medigap to Medicare Advantage

Can you switch from Medigap to Medicare Advantage? Absolutely. You can drop your Medigap coverage at any time. But you need to think carefully about the timing before you drop your plan.

You can switch from Medigap to Medicare Advantage during the Medicare Annual Enrollment Period (AEP), which runs from October 15th to December 7th each year, or during any other enrollment period for which you qualify. During this period, you can enroll in a Medicare Advantage plan and drop your Medigap plan. Your new coverage will start on January 1st of the next year. 

You cannot be enrolled in a Medicare Advantage plan and a Medigap plan at the same time. During the AEP, you will need to enroll in your new Medicare Advantage plan, and you’ll also need to leave your Medigap plan.

Finding a Medicare Advantage Plan

To choose a Medicare Advantage plan, think carefully about the options available in your area. Look at all the covered benefits, check the drug coverage, and compare monthly premiums. Enrolling in a new Clover Health Medicare Advantage plan is easy. You can enroll online or over the phone. Just make sure all your enrollment forms are completed and submitted before December 7th.

Clover Health Plans

Clover Health members get a Medicare Advantage plan with great benefits. Plans include vision, dental, and hearing coverage, along with a yearly cap on costs. You’ll get 24/7 access to doctors and most plans have an over-the-counter allowance to keep your medicine cabinet stocked and your wallet full. We have plans starting as low as $0 per month, and all our plans have $0 to low premiums and copays. To learn more about Clover Health, call us at 1-800-836-6890* and find out if Clover Health is right for you.