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Medigap Differ from Medicare Advantage

A lot of people including insurance agents will brush over How Medigap differ from Medicare Advantage.  The difference between the two are night and day, and choosing one may have lifelong implications.

What do you do, when it’s time to choose how you want to receive your Medicare benefits?  I can’t stress this enough, one needs to pay close attention to the details not the marketing.  There are two ways to receive your Medicare benefits:

  1. Traditional Medicare with a Supplement (Medigap), and Prescription Drug Plan (Part D)
  2. Medicare Advantage (Part C)

Network of Providers

With traditional Medicare and a Medigap, you can go to and self-refer to any provider in the country that accepts Medicare.  This is most doctors out there and can be easily researched from the website.  The propaganda machine of the media will tell you otherwise.

Typically speaking on a Medicare Advantage plan you must use there network of providers.  This includes getting a referral from your Primary Care Physician (PCP) to see a specialist.  The exception to this is if you have a medical emergency out of network.

Co-pays / Co-Insurance

With traditional Medicare and a Medigap plan, (depending on the Medigap plan letter) you choose, you will not have co-pays or co-insurance to pay.  Go to the doctor, go to the hospital it will be paid for by Medicare and your Medigap plan.  Same goes for if you want a second opinion from another doctor or if you want to go to a specialist in another state.

On a Medicare Advantage plan typically you will have a co-pay and or co-insurance from the doctor or hospital you have visited to pay.  The protection that the Medicare Advantage plan offers is it will have an out of pocket maximum that you are limited to assuming you go to in network providers.

Changing Plans

With a Medigap plan you can change anytime throughout the year.  If you don’t like the carrier, they raised there rates or whatever your reason is we can change the plan anytime.

With a Medicare Advantage plan you can only change once a year during the annual election period (AEP).  The exception to this is if you qualify for a special election period (SEP).  The unfair part of this is your doctor or hospital of choice can choose to leave the Medicare Advantage plans network anytime in the year.  Than you are left with having to change your doctor, or going to a hospital that you may not like.  This typically happens when the doctor or doctor group get’s into a fight with a Medicare Advantage plan over reimbursement.  Also knows as MONEY!!

Traveling Domestically

You’re retired now and you want to travel the open roads, or rail.  I don’t blame you, and would like to do that myself.  Or maybe you are a snow bird, or a heat bird.

With traditional Medicare and your Medigap plan you are fully covered in all 50 States, plus Guam, Puerto Rico, and the US Virgin Islands.  Whether you got sick, injured or wanting a second opinion you are covered.

On a Medicare Advantage plan you must go to in-network doctors and hospitals while traveling domestically, unless it is a medical emergency.


Here’s a big difference, and when I say big, I mean huge.

On traditional Medicare and a Medigap, typically you will pay more on a monthly basis and little to no co-pays or co-insurance.

With a Medicare Advantage plan typically you will pay little to no monthly premiums but you will typically pay co-pays and co-insurance.

So as to not be accused of beating around the bush about the costs, typically here in Washington State we see yearly premiums for Medigap plans to be around $2,000.

The out pocket maximums we see for Medicare Advantage plans is $6,700.

One can see if you are not healthy or become sick you could easily be spending $6,700 a year in co-pays and co-insurance.  In fact Kiplinger did a article about that.

Can I have My Cake and Eat it To

Can I save money now?   By going with a cheaper Medicare Advantage plan, and then when I get sick switch to a Medigap plan.  This is a great question and one that get’s asked frequently.  The answer is maybe.  When you first qualify for Medicare you can qualify for any plan you choose without Medical questions being asked.  However outside of that you must be able to pass the medical underwriting of the Medigap company in order to qualify.

Why are Medicare Advantage Plans so Cheap

That is another great question.  When you sign up for a Medicare Advantage plan you are essentially signing over your Medicare benefits to the Medicare Advantage company.  That includes the monthly premiums associated with Part A and Part B.  Depending on where you live this could be $800 – $1200 a month that the Medicare Advantage insurance company is receiving from Medicare.  The insurance companies are also reimbursed extra if you are more sick than normal.  They aren’t giving you lower premiums out of the goodness of their heart!

What’s In It For Me

A fair question.  As much as I like helping people with there Medicare options, I also like to provide for my family.  If you allow me to be your insurance agent for your Medicare option, I won’t charge you a dime.  Instead the insurance company will pay me a commission, when I help you buy a policy.  They will pay this commission without charging you any extra in premium!  So in essence you get us, our years of experience and yearly hours of continuing education for free.

I am an independent broker, who is not beholden to one insurance company, but to you my client.  I would love to help you just like I’ve helped hundreds of others with the proper coverage at the lowest price.  Call 352-508-4221 or fill out the form to the left.

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