Friday, December 2, 2022

How To Decide Between Medicare Advantage And Medigap

Don't Miss

Best Discounts For Multiple Policyholders: Cigna

Medicare Advantage vs Medigap – Which to Choose?

Cigna

  • Fewer plan options than some other companies

  • No pricing listed on the site without providing personal information

Cigna offers the best premium discounts for healthy policyholders as well as households with multiple policies through Cigna, including a 7% household discount and a 5% discount for online sign-up that remains in effect for the life of the policy . While Cigna offers fewer plans than some of its competitors its easy-to-use website has information clearly separated into categories, with an itemized breakdown of each plan when you click on “details” in the plan comparison chart. This allows for easy comparisons while avoiding presenting too much information at once. Cigna also offers a short educational video to explain “the basics of Medicare Supplement insurance.”

Cigna has been in business since 1792, making it one of the oldest companies we reviewed, and the company’s financial strength is currently an A according to AM Best. If youre willing to answer some detailed health history questions, you can see personalized quotes on the website, or you can contact them by phone.

Can You Switch From Medicare Advantage To Medigap

You can technically leave your Medicare Advantage plan at any time and enroll in Medigap. The issue, however, is whether the Medigap carrier will accept you. If youre outside your one-time Medigap OEP, you no longer have guaranteed issue rights and you will have to go through medical underwriting.

If you enroll in Medicare Advantage because youre healthy, then you likely wont be able to enroll in Medigap in the future if youre diagnosed with a serious condition or illness. Your diagnosis will likely be considered a pre-existing condition.

If you enroll in Medicare Advantage but decide later you arent happy with the high cost-sharing, the carrier will accept you into the plan if you have no health issues. Youll pay higher monthly premiums, however, since youre older now.

There is a special enrollment period called trial rights, which is a 12-month window that allows you to leave your Medicare Advantage plan and enroll in a Medigap plan without going through medical underwriting. Youre eligible for trial rights only if you enrolled in Medicare Advantage when you were first eligible for Medicare or if you left your Medigap plan for a Medicare Advantage plan. You can use trial rights only once.

Which Is Better: Medigap Or Medicare Advantage

Neither type of policy is necessarily better than the other. But one option may prove to be better for a particular persons needs.

If you need to choose between a Medigap plan and a Medicare Advantage plan or would just like some further information about these policies and how they differ, consult with a licensed insurance agent who can walk you through some of the subtleties and help you determine the best type of Medicare plan for your needs.

Read Also: How Much Does Medicare Pay For Hospice

Costs Of Medicare Advantage

Medicare advantage premiums vary like any other insurance plan, based on the provider and the plan you select.

Some programs have no monthly fees, while others charge hundreds of dollars. However, its uncertain whether your Part C premium will be higher than your Part B premium.

Costs such as copays and deductibles will also vary depending on the plan. When it comes to evaluating future expenses for your Medicare Advantage plan, properly comparing programs while shopping is your best chance.

Other factors that may influence Medicare Advantage plan costs include:

  • How often youd like to use medical services
  • The location of your medical care
  • Your earnings
  • If you receive financial help such as Medicaid or if you have a disability

You Can’t Have Both So You Must Choose Wisely

What Is the Difference Between Medicare Advantage and Medigap?

Consumer ReportsOncology TimesMEDICAThe New York Times MagazinePsychology TodaySports Illustrated

Our editors independently research and recommend the best products and services. You can learn more about our independent review process and partners in our advertiser disclosure. We may receive commissions on purchases made from our chosen links.

Anyone who’s ready to sign up for Medicare has a lot of decisions to make. But one decision is especially importantshould you choose Medicare Advantage or use Medigap to supplement your Original Medicare plan?

You May Like: Is Medicare Advantage Part Of Medicare

When Can I Buy A Medicare Supplement Plan

When it comes to Medicare eligibility, you can buy a Medicare Supplement policy beginning on the first day of the month you turn 65, and for the following six months. Depending on the plan and state, however, people who are under 65 may qualify if they are permanently disabled. You may be subject to a medical underwriting examination, which is a detailed review of your medical history.

When Might Medicare Advantage Be Right For You

A Medicare Advantage plan might be ideal for beneficiaries who want dental, vision or hearing coverage but do not have it through other means.

Because Original Medicare does not provide any routine coverage in those areas, beneficiaries are left to purchase a standalone policy on the private market or pay for such care out of pocket. But many Medicare Advantage plans allow for a third option: Bundle coverage for dental, vision and hearing care along with your Medicare Part A and Part B benefits to have everything you need under the umbrella of just one policy, with one Medicare insurance card.

If you wear glasses or hearing aids and wish to have coverage for the services and products you need, a Medicare Advantage plan may be right for you. And everyone should have adequate dental coverage, particularly older adults who may need dentures, bridges or other dental work.

Many Medicare Advantage plans also include prescription drug coverage, which is also something not included under Original Medicare but needed by so many older adults.

Whats more is that many Medicare Advantage plans offer $0 monthly premiums.

Another situation in which Medicare Advantage may be right for you is if you wish to have protection against unexpectedly high medical costs and surprise medical bills. Original Medicare has no annual out-of-pocket limit, which means beneficiaries may be left responsible for potentially financially crippling medical bills in the event of a serious illness or injury.

Recommended Reading: How To Get Medicare Advantage Plan

When To Sign Up For Medicare

As you approach age 65, its important to know which enrollment deadlines apply to your circumstances. Begin by checking on your eligibility. To avoid costly penalties and gaps in coverage, most people should for Medicare Part A and Part B in the seven-month window that starts three months before the month you turn 65 and runs for another three months following your 65th birthday.

If you currently get Social Security, you will be automatically enrolled if not, you need to sign up either online or at your Social Security office.

Medicare Advantage Also Known As Medicare Part C

Choosing Between a Medicare Supplement and a Medicare Advantage Plan

Medicare Advantage , also called Medicare Part C, is a type of private Medicare health plan sold by insurance companies. These plans replace your Medicare Part A and Part B coverage and offer all of the same benefits you would otherwise receive from Medicare Part A and Part B. In fact, they are required by federal law to cover everything that Original Medicare covers.

Beyond the minimum coverage requirement, most Medicare Advantage plans also offer benefits that are not covered by Original Medicare. Some of the most popular extra benefits that some Medicare Advantage plans may offer include coverage for things like:

  • Routine dental care, such as teeth cleaning
  • Dentures
  • Routine vision care such as eye exams and prescription eyeglasses or contacts
  • Hearing care and hearing aids
  • Membership to fitness programs such as SilverSneakers and Silver& Fit

Most Medicare Advantage plans include prescription drug coverage. These plans are often referred to as Medicare Advantage Prescription Drug plans .

Its important to note that the specific Medicare Advantage plans and benefits that are available where you live may vary.

Some Medicare Advantage plans may even cover things like acupuncture, non-emergency medical transportation, home modifications for aging in place, home meal delivery and more.

Read Also: How Do You Pay Medicare

Coverage Outside The State Or Country

If you tend to travel a lot, Medigap has a clear bonus for you. It works anywhere that Medicare is accepted, whether you’re in or out of state. Many plans cover health care outside the U.S., as well, for certain emergencies.

Medicare Advantage may be limited for out-of-state travel, and it does not apply for travel outside the U.S.

The Freedom To Choose Your Own Doctors And Hospitals

Medicare Advantage: Your choice of physicians and facilities may be limited to the plans network, whether it is HMO or PPO. You might also need a referral from a primary care physician before seeing a specialist.6

Medigap: You are free to visit any doctor or facility that accepts Medicare, and you dont need referrals to see specialists.8

Also Check: How To Apply For Medicare In Hawaii

Medicare Primer: Advantage Or Medigap

Traditional Medicare with a Medigap plan or Medicare Advantage? My Aunt Carol in Orlando wrestled with this decision for some five hours in sessions with her Medicare adviser, which she followed up with multiple phone calls and a raft of additional questions.

You have to ask these questions. You really have to think about it, she said. Its confusing.

Essentially every 65-year-old American enrolls in Medicare, and many get additional coverage. One form of additional coverage is through supplements to traditional Medicare, which include a Part D prescription drug plan and/or a Medigap private insurance plan to cover some or all of Medicares co-payments, deductibles, and other out-of-pocket costs. The other is through Medicare Advantage, a managed care option that typically provides prescription drug coverage and other services not included in the basic Medicare program.

So which to choose? Consumer choices have proliferated since private plans were added to Medicare 40 years ago. The typical beneficiary today has about 18 Medicare Advantage options, a multitude of Medigap plans for people who choose the traditional route, and 31 prescription drug programs, according to the Kaiser Family Foundation.

This primer is for new enrollees like my aunt. A future blog will provide suggestions from leading Medicare experts about ways to think about this important decision and the financial issues at stake.

Can You Change From A Medicare Advantage Plan To A Medicare Supplement Plan

Choosing Between Medicare Advantage and Medigap

During the Annual Enrollment Period, which runs from October 15 to December 7 each year, you are free to reconsider your Medicare coverage. If you decide you want to try a Medicare Supplement plan vs. Medicare Advantage plan, you can make that change during this period.4

Considering Medicare Advantage vs. Medicare Supplement? One is not better than the other. They provide different types of coverage. Finding the right fit for you depends on what kind of Medicare coverage youre seeking, as well as your health care needs. Review all details of plans when shopping and be open to considering alternatives when your needs change.

Don’t Miss: What Age Does Medicare Take Effect

Considerations For Medicare Advantage

If you meet the following criteria, Medicare Advantage may be a suitable option for you:

  • Parts A, B, and D are already in your possession.
  • You already have a preferred approved provider who accepts Medicare and Medicare Advantage insurance.
  • You want additional benefits, such as hearing, vision, and dental, to be covered.
  • Youd prefer to handle a single insurance plan for all of your needs.

If you meet the following criteria, Medicare Advantage may not be a good fit for you:

  • You travel or plan to travel a lot while on Medicare.
  • You want to stick with the same insurance provider year after year.
  • Youd like to maintain the same rate.
  • Youre worried about overpaying for coverage youll never use.

Is It Better To Have Medicare Advantage Or Medigap

Medigap is the policy you want if something goes wrong with your health. Medicare Advantage plans can save you money when you dont use any of the medical services, but there are limitations to these policies.

So, will you take a gamble on good health with a Medicare Advantage plan? Or, will you sleep well knowing that IF something goes wrong, you have the coverage you need?

It has never been about which is the best, its about the option thats best for you. Our recommendation will always be Medigap because we know at the end of the day, having the coverage you need is better than just having a low premium.

Read Also: How To Change Medicare Direct Deposit

What Are The Benefits To Medicare Advantage

Medicare Advantage covers more than Medicare , allowing patients more options and flexibility. Patients can customize their Medicare Advantage to cover specific needs like wheelchair ramps, adult day care, and respite care. Additionally, the 2020 CARES Act expanded Medicare’s network to cover more telehealth services.

Detailed Overview Of Medicare Advantage Vs Medigap

Medigap vs Medicare Advantage – Learn How to Choose the Right Plan

Price

Medicare Advantage plans usually have a zero monthly premium, however, some of the more comprehensive plans can have a premium. An example of this is below. Medigap premiums vary based on the Plan letter, age, zip code, etc. For our examples, well pick a zipcode at random 30303 in Atlanta, Georgia. Well use a 65-year-old female who does not use tobacco. The lowest cost Plan F as of this writing is $138.75 monthly. The lowest cost plan G is $109.50 and the lowest cost Plan N is $92.58.

On the price front, its important to note that regardless of which option you have, you must continue to pay your Part A and Part B premium. For most people, Part A is no cost as you paid it during your working years. For those wondering about Part B costs. Good question, however, we do have a separate article on the topic because its based on income and can be complicated. See: How much is Medicare Part B

Network

As stated above. Medicare Advantage plans have networks where Medigap plans do not. With a Medigap plan, you may visit any provider you wish as long as they take Medicare. This is very easy to do via medicare.gov/physiciancompare/.

Ability to Purchase

This is a very big difference between the 2. Medicare Advantage plans can be purchased when you turn 65, and every year thereafter during AEP . There are no medical questions, and as long as you are not in end-stage renal failure, you can get a plan.

Stability

Part D Prescription Coverage

Chemotherapy

Extra Benefits

Read Also: How Many Days Does Medicare Cover Skilled Nursing Facility

How Do You Select A Medicare Supplement Insurance Company That Works For You

After youve researched and compared companies, you will select a supplemental insurance company that works best for you. You will want to consider things like the reputation and reviews of the insurance company as well as how easy it is to navigate their website and apply for coverage. Additional factors to consider include types of plans available, pricing, and deductibles. You may also want to select a company that has an app so you can manage your policy on the go.

How Do You Shop And Compare Medicare Supplement Plans

Researching the plan thats right for you is key to getting the coverage you need. Each plan offers specific benefits depending on your state, which benefits you desire, and the costs.

Step 1: Determine if You Are Eligible to Enroll

In general, if you’re approaching your 65th birthday, but you haven’t started taking Social Security benefits yet, you are eligible for Medicare.

The best time to buy a Medicare Supplement policy is during your Initial Medicare Open Enrollment Period. This is a one-time only, six-month span when federal law allows you to sign up for any Medicare Supplement policy you want that is sold in your state. Preexisting conditions are accepted during this time period, and you can’t be denied a Medicare Supplement policy or charged more due to past or present health problems. Make sure you know when your Open Enrollment Period starts.

Step 2: Find a List of Medicare Supplement Plans Available in Your State or ZIP Code

Using the tool available on Medicares website, you can search for coverage plans based on your location.

Step 3: Determine Which Aspects of Coverage Are Most Important to You

Perhaps you are concerned about out-of-pocket copays or high deductibles or you have a preexisting condition and want to know if there is a waiting period for coverage for it. Be sure to check each plan for the details that matter most to you.

Step 4: Compare the Difference in Cost Among Medicare Supplement Plans

Step 5: Consider Talking to a Broker or Consultant

You May Like: Does Medicare Pay For Custom Foot Orthotics

How To Switch From Medicare Advantage To Medigap

Here are the steps youd take to switch from an MA plan to Original Medicare with a Medigap policy during a qualifying circumstance or enrollment period:

  • To disenroll from an MA plan, you can:
  • Contact the plan directly and request a disenrollment form
  • Contact Medicare and ask for disenrollment from your plan
  • Visit your local Social Security office
  • If you had Medigap coverage before joining a MA plan and have had your MA plan for less than one year, you can return to your previous Medigap policy.
  • Best User Experience: Humana

    Can I Switch from Medicare Advantage to Medigap ...
    • Some of the deductibles run higher than other plans

    • Lack of detailed educational information about each plan’s coverage

    • Not available in all 50 states

    Humana’s website offers easy-to-use, self-explanatory content that makes the process of finding the best Medicare Supplement policy simple and straightforward. Each plans coverage details are clearly displayed by ZIP code, without needing to enter your personal information into the site. You can also request an in-person appointment with a Humana Medicare agent.

    You can compare specific plans if you enter your personal data, and Humana also provides a PDF with detailed plan information by state. Deductibles for some Humana plans are a little higher than other carriers. Humana covers every state with the same basic plans, including Parts A, B, C, F, G, K, L, and N. Plan F has an additional high-deductible option.

    Humana earns an A- with AM Best for financial health. The MyHumana app is available from both Google Play and Apple’s App Store.

    Recommended Reading: Does Humana Medicare Cover Incontinence Supplies

    More articles

    Popular Articles