Should I Choose Medicare Advantage Or A Medigap Plan?Medicare Advantage Or Medigap: How Californians Choose.
Both paths cover what Original Medicare covers. They differ in who you can see, how you pay and how easily you can change your mind later, and California adds a rule of its own.
The Short Answer
Medicare Advantage is another way to get Medicare: a private plan, usually with a provider network, a yearly limit on what you pay and drug coverage included. Medigap is a supplement added to Original Medicare that helps pay your share of costs at any doctor who takes Medicare. Your doctors, travel and health decide the fit.
Source: Medicare.gov
Three Windows That Shape The Choice
- 12 Months
- Your trial right: join Medicare Advantage at 65, and you can switch back and buy certain Medigap policies within the first year.
- 60 Days
- California’s yearly window, starting on your birthday, to move to a Medigap plan with equal or lesser benefits.
- Jan 1 – Mar 31
- Medicare Advantage members can switch plans or return to Original Medicare once in this period.
Source: Medicare.gov and the California Department of Insurance
Side By Side
Medicare Advantage And Medigap, Compared On Cost And Flexibility
Medicare.gov’s own terms, arranged around the questions that decide it for most people choosing their coverage.
| Question | Medicare AdvantageOne Private Plan, Usually With A Network | Original Medicare Plus MedigapA Supplement Added To Parts A And B |
|---|---|---|
| What You Pay Each Month | The Part B premium, plus any plan premium. Some plans charge $0 and help with Part B. | The Part B premium, a Medigap premium and a separate Part D premium for drugs. |
| When You Get Care | Out-of-pocket costs vary by plan and service, up to the plan’s yearly limit. | Medigap helps pay costs like your 20% Part B coinsurance, depending on the plan letter. |
| Prior Approval | You may need the plan’s approval before it covers certain services or supplies. | In most cases, Original Medicare needs no prior authorization. |
| Extra Benefits | Plans may offer extras such as some vision, hearing and dental services. | Medigap generally excludes vision, dental, hearing aids and long-term care. |
| Comparing Prices | Networks, costs and extras differ by plan, so check each against your doctors and drugs. | Each lettered plan has the same benefits at every insurer, so price is the difference. |
| Coverage For A Couple | Each spouse joins a plan, and most plans include drug coverage. | A Medigap policy covers one person, so each spouse buys their own. |
| Changing Your Mind | You can return to Original Medicare at set times, but a Medigap policy may be hard to get then. | Switching Medigap policies later can mean medical underwriting outside protected windows. |
The right column depends on your doctors, your prescriptions and how much flexibility you want later. Source: Medicare.gov.
What Is The Difference Between Medicare Advantage And Medigap?
They solve the same problem in opposite ways. Original Medicare leaves you a share of most bills, such as 20% of the Medicare-approved amount for Part B services after the deductible, with no yearly limit. A Medigap policy is extra insurance that helps pay that share. You keep Original Medicare, use any doctor or hospital in the U.S. that takes Medicare and add a Part D plan for drugs.
Medicare Advantage takes a different route. Medicare-approved private companies offer these plans and must follow rules set by Medicare. A plan usually uses a network, caps what you pay each year and builds in drug coverage. You choose one path or the other: you can’t have Medigap and Medicare Advantage at the same time.
Which Costs More, Medicare Advantage Or Medigap?
It depends on how much care you use. Some Medicare Advantage plans carry a $0 premium and help pay part of your Part B premium, but you pay copays or coinsurance when you get care, up to the plan’s yearly limit. Medigap works the other way around: you pay a monthly premium to the insurer on top of Part B, and the policy helps pay the copays, coinsurance and deductibles Original Medicare leaves to you.
Medigap premiums vary widely by company, plan and where you live, and Medicare.gov notes they typically increase each year. Because each lettered plan carries the same benefits at every insurer, compare the same letter across companies, for example Plan G from one company with Plan G from another.
Can I Switch From Medicare Advantage To Medigap Later?
You can leave Medicare Advantage for Original Medicare during Open Enrollment, October 15 to December 7, or during the Medicare Advantage Open Enrollment Period, January 1 to March 31. Getting a Medigap policy at that point is the hard part. Outside your protected windows, an insurer can deny you a Medigap policy if you don’t meet its medical underwriting requirements.
Medicare.gov describes one important exception, the trial right. If you joined a Medicare Advantage plan when you first became eligible at 65, you can buy certain Medigap policies if you switch back to Original Medicare within the first year. If you dropped a Medigap policy to try Medicare Advantage for the first time, you have 12 months to get that policy back if the same company still sells it.
What Is California’s Medigap Birthday Rule?
California adds a yearly protection on top of the federal rules. According to the California Department of Insurance, if you already have a Medicare Supplement policy, you can transfer to an equal or lesser Medicare Supplement plan during a 60-day open enrollment period that begins on your birthday. Your insurer must tell you about this right 30 to 60 days before your birthday.
The Department’s guidance adds that you can buy the new policy without a medical screening or a new waiting period, as long as it has the same or lesser benefits. That can mean the same plan letter from a different insurer if its premium suits you better. The rule applies only to people who already hold a Medigap policy, so it can’t open the door for someone leaving Medicare Advantage.
How Do My Doctors And Travel Change The Answer?
Start with the people who treat you. With Original Medicare and Medigap, any doctor or hospital in the U.S. that takes Medicare works, and in most cases you don’t need a referral to see a specialist. With Medicare Advantage, you may need to use doctors in the plan’s network and service area for non-emergency care, so check every doctor and pharmacy before you join.
Travel matters too. If you live in another state for part of the year, Medicare.gov suggests checking whether a plan will cover you there. Outside the U.S., Original Medicare generally doesn’t pay. Some Medigap policies cover emergency care abroad, and some Medicare Advantage plans add emergency and urgent care abroad as an extra benefit.
When Should I Make The Decision?
The first decision carries the most weight, because your 6-month Medigap Open Enrollment Period and your trial right both begin around 65. During that window, insurers must sell you any Medigap policy they offer without charging more for pre-existing health problems. After it, the same policy may cost more or be out of reach.
That is why Maartin begins with your doctors, prescriptions and travel, then lays the plans he represents side by side before you choose. You decide, and in California you enroll directly with the insurance company. Medicare plan calls are recorded under federal rules, so expect that when you talk by phone.
Next Step
Talk It Through
A private conversation with Maartin about how this fits your own plan. In person on Arlington Avenue, by Zoom or by phone.
Book A Medicare Review Or call 951.774.0866Questions
Common Questions
Can I have Medicare Advantage and Medigap at the same time?
No. Medicare.gov says that when you get started with Medicare you can either buy Medigap or join a Medicare Advantage plan, but you can’t have both. Medigap also can’t be used to pay Medicare Advantage copayments, deductibles or premiums.
Does Medigap include prescription drug coverage?
Medigap plans sold after 2005 don’t include drug coverage. To cover prescriptions with Original Medicare and Medigap, you join a separate Medicare drug plan (Part D).
Can I still buy Medigap Plan C or Plan F?
It depends on when you first became eligible for Medicare. Medicare.gov notes that not everyone can buy Plan C or Plan F, so check your eligibility date before you compare those plans.
Does my spouse need a separate Medigap policy?
Yes. A Medigap policy covers one person, so if you and your spouse both want Medigap, you each buy your own policy.
Can my Medigap policy be canceled if my health changes?
Standardized Medigap policies renew automatically every year, even if you have health problems. Medicare.gov says the insurer can drop you only if you stop paying premiums, weren’t truthful on the application or the company goes bankrupt or out of business.
Does a Medicare Advantage plan cover everything Original Medicare covers?
Yes. Plans must cover all medically necessary services that Original Medicare covers, and they may add extras such as some vision, hearing and dental services. You may need the plan’s approval before it covers certain services.
Sources
- Medicare Advantage is another way to get Medicare; Medigap supplements Original Medicare; you can’t have both
- Medicare Advantage plans are offered by Medicare-approved private companies
- Medigap helps pay Original Medicare out-of-pocket costs like copayments, coinsurance and deductibles
- Doctor choice, referrals, 20% coinsurance, no yearly limit vs yearly limit, premiums, prior authorization, drug coverage, extras and travel
- Medigap premiums vary widely, typically increase each year; same lettered plan has same benefits; compare same letter
- Medigap generally doesn’t cover long-term care, vision, dental, hearing aids; plans sold after 2005 have no drug coverage
- Open Enrollment October 15 to December 7; Medicare Advantage Open Enrollment January 1 to March 31 for current members; check coverage in another state
- Outside Medigap Open Enrollment, insurers may deny coverage on medical underwriting
- California birthday rule: 60-day open enrollment beginning on your birthday to transfer to an equal or lesser Medicare Supplement plan; notice 30 to 60 days before
- Birthday rule: no medical screening or new waiting period; same or lesser benefits; applies to people who already have Medigap
- Federal law generally gives no right to switch Medigap policies outside open enrollment or guaranteed issue
- Not everyone can buy Plan C or Plan F
Medicare Disclaimer
We do not offer every plan available in your area. Currently we represent 6 organizations which offer 87 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Not affiliated with or endorsed by the U.S. government or the federal Medicare program.
Please Note
Education, not advice. MJR Financial & Insurance Services does not give tax, legal or Social Security advice; please consult your own professionals.
Choosing Your Path?
Two Paths,
One Clear Comparison.
Bring your doctors, prescriptions and travel plans, and Maartin lays both paths side by side.
Book A Medicare ReviewRead The Questions Families Ask FirstVisit The Office On Arlington Avenue