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Medicare Medigap vs Advantage

Medicare Medigap vs Advantage

Many patients have been asking me about the difference between standard Medicare with a supplemental plan versus a Medicare Advantage plan and which one I recommend. Well, the easy answer is…it depends.

Straight Medicare typically covers about 80% of services, leaving the patient responsible for the remainder. If a supplemental plan like AARP is in place, it will cover the difference between Medicare and the final price, or the "Gap," hence the term Medigap.

Some benefits of a Medigap plan over an Advantage plan include:

  1. Freedom to Choose Providers: With a Medigap plan, you can usually see any Medicare-accepting doctor or specialist. There are no networks, so you have more freedom in choosing healthcare providers.

  2. Predictable Costs: Medigap plans often have more predictable out-of-pocket costs because they cover expenses like deductibles and coinsurance that Medicare doesn't. This can make budgeting for healthcare expenses easier.

  3. No Referrals Needed: You don't need referrals to see specialists with a Medigap plan. If you need to see a specialist, you can typically make an appointment without approval from your primary care doctor.

  4. Coverage Nationwide: Medigap plans provide coverage nationwide, so you're still covered if you travel or move to another state. You don't need to worry about whether your plan will be accepted outside of your local area.

  5. Stability: Medigap plans tend to have more stable coverage from year to year. The benefits of Medigap plans are standardized by the government, making it easy to compare plans and understand what you're getting.

Seniors playing in the part

From the doctor’s perspective, Medigap plans minimize administrative burden as referrals are unnecessary and pre-authorization for medications and procedures is minimal. For this reason, I personally prefer the medigap plans, but they are not the best choice for everyone.

An Advantage plan may offer additional benefits beyond what Original Medicare covers, such as prescription drug coverage, dental, vision, hearing, and wellness programs. For some, this may result in lower medical costs as the monthly premium covers all additional benefits.

Which is better?

In general, for those with multiple medical issues and frequent doctor visits, the best plan, in my opinion, is Medigap. You are not limited to specific doctors and facilities, and there's no hassle with referrals and pre-authorizations.

However, if you're healthy and rarely use the medical system, an Advantage plan may be a better fit.

Just remember, in some locations, such as Santa Fe where I practice, Advantage plans may have very few specialists available. To see an in-network doctor, you may have to travel quite a distance, whereas with Medigap, you can see any provider who accepts Medicare.

This can be an extremely confusing topic, and we're happy to discuss the pros and cons of each with our patients. If you need help determining what option would be best for you, please click the link below and schedule a FREE 15 minute Meet and Greet appointment.

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