Medicare Advantage & Medigap Cost Differences

Original Medicare is Part A and part B. It will cover many if not most of your medical needs, but there are certainly gaps. That is why many people look to either a Medicare Supplement Plan or a Medicare Advantage plan. However, they are entirely different.

Medicare supplements will fill in the financial gaps of Original Medicare, but will not offer additional benefits. You will still have the full original medicare network. Medicare advantage will replace original medicare entirely. It must offer at least the same benefits, but plans may offer additional benefits as well. Let’s break down the cost differences.

Premium

If you choose a medigap plan, you will have to pay an additional monthly premium on top of whatever you pay for Original Medicare. There are many plans to choose from and your monthly premium is determined by your age, location, and the carrier that you choose. Your medical history can also come into play if you enroll outside of your iep (the 6 months after you turn 65 and enroll in medicare part B). Outside of your IEP, you may be subject to medical underwriting. BUT, generally speaking, monthly premiums range between $100-$200.

Medicare Advantage is different. It doesn’t work with Original Medicare, bur rather in place of it. Your plan may just require you to continue to pay for Medicare Part B. Very often, these types of plans claim that they are “free”, but that is simply not true. Some plans, may even offer you a credit back towards your Part B premium.

Monthly premiums are usually pretty inexpensive, which can be a major draw. Remember, that nothing is free and if you are getting a “deal” on your insurance, there may be other areas lacking in the form of smaller networks or higher copays.

Deductible

There are also deductibles to take into consideration. Your deductible is the amount you have to meet out of pocket before your insurance begins to contribute to the cost share.

Original Medicare is divided into two parts: Part A & Part B. Part A is your hospital insurance. If you need to be hospitalized or utilize your Part A services, you’ll first need to meet a deductible of $1556. This is the deductible for 2022. This deductible is applied per benefit period.

Many Medicare Supplement plans cover the Part A deductible. This means that you will not have to pay the deductible out of pocket if you need to be hospitalized.

Part B is your outpatient insurance. In 2022, the deductible is $233. None of the medigap plans will cover this, so you will need to meet the Part B deductible.

For Medicare Advantage plans, deductibles may vary. Some plans will offer a $0 deductible, but because plans are not standardized, there is a pretty wide range.

Copays & Coinsurance

The amount that you pay for copays or coinsurance with medigap depends on the plan that you choose.

For Part C Plans, the amounts can vary widely because the plans are not standardized. Very often copays for doctor’s visits and specialists will be pretty low. You can see the exact terms of your plan on Medicare.gov.

Out of Pocket Maximum

Finally, whether you choose a supplement plan or advantage plan, you will have some type of out of pocket max. Original Medicare alone does not offer an OOP max, so this is a very good thing.

Many medigap plans cover all of the additional expenses, so you won’t have an additional expenses. The only exceptions to this are Plans K & L which are the cost sharing plans. In 2022, the OOP Max for Plan K is $6,620 and for Plan L it’s $3,310.

For Medicare advantage it can range from about $1000 to a few thousand dollars. Again, you can see that very clearly on medicare.gov.

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