What’s the Difference Between Medicare and Medigap?

WHEN IT COMES TO signing up for Medicare, there’s plenty of confusion. Which part of the four-part program covers hospital stays? Do all plans help pay for prescription drugs? What’s the difference between original Medicare, Medicare Advantage and Medicare supplemental insurance?

The Four Parts of Medicare

Medicare itself has four parts. Part A (hospital insurance) and Part B (medical insurance) come standard in every original Medicare plan. Part C is called Medicare Advantage, an alternative to original Medicare that offers additional benefits like prescription drug coverage. Stand-alone prescription drug plans, or Part D, cover prescription drugs for those on original Medicare, which does not include any drug coverage — other than medications administered in a doctor’s office. And then there is Medigap or Medicare supplemental insurance.

[Read: Medicare vs. Medicare Advantage: How to Choose.]

Types of Medicare Supplemental Insurance

Medicare supplemental insurance can help you pay for the “gaps” in your original Medicare policy — such as co-payments at a doctor’s office, coinsurance at skilled nursing facilities and hospital costs not covered by Medicare Part A. There are 10 types of Medicare Supplement Insurance plans, each designated by a letter of the alphabet (you can find details about all 10 plans at Medicare.gov). However, two of these have not been available to new members since January 1, 2020. In most states, the benefits for each of these ten plans are the same no matter what insurance company you purchase the plan from, though each of the lettered plans covers different things. Premium prices for each of the 10 Medigap plans vary depending on the benefits offered, and these premiums are in addition to your regular Medicare premiums.

[READ: Medicare vs. Medicaid: What Is the Difference?]

Who Is Eligible for Medigap Insurance?

To qualify for Medicare supplemental insurance, you must already have original Medicare Parts A and B. The most comprehensive Medicare Supplement Insurance plan is Plan F, which covers an extensive array of benefits. Plan F is understandably the most popular plan, according to Joe Baker, president emeritus of the Medicare Rights Center, a nonprofit that helps older adults understand Medicare benefits. However, these plans have not been available to people new to Medicare since January 1, 2020. Individuals who were eligible for Medicare as of January 1, 2020, but not yet enrolled may still be able to buy one of these plans and individuals who enrolled before January 1, 2020, have been allowed to keep their plan since the rule change.

New members who are not eligible for Plan F may want to consider Plan C, which covers nearly everything Plan F covers except excess charges. Excess charges allow a physician to charge up to 15% above the Medicare-approved amount, and this is passed on to the patient and billed directly to them.

Medicare supplemental insurance plans are renewable regardless of health status. As long as you pay your monthly premium, your insurance carrier generally cannot terminate your policy. Prices depend on your age, where you live, the insurer and the type of plan you select. In general, Medicare supplemental insurance plans usually do not cover long-term care, vision or dental care, hearing aids, eyeglasses or private-duty nursing. A Medicare supplemental insurance plan can also only cover one person. If your spouse wants Medicare Supplement benefits, they will need a separate policy.

Individuals who choose to enroll in a Medicare Advantage plan are not eligible for a Medicare supplemental insurance plan. Only those on original Medicare can sign up.

The Benefits of Medigap Insurance

The advantage of a Medicare supplemental insurance plan is that you may have a more extensive network of providers to choose from. If you have a health condition, a Medicare supplemental insurance plan will cover more of your medical expenses. These plans may save you a lot of money in the long run if you need extensive medical services or treatments, such as taking many prescription medications.

[READ: Medicare Mistakes to Avoid.]

Choosing a Medigap Plan

Regardless of whether you opt to buy a Medicare supplemental insurance plan or a Medicare Advantage plan, Baker advises exploring plan details and speaking with providers and others who have already purchased the plan you are considering.

When to Enroll in a Medigap Plan

The best time to buy a Medigap policy is during your six-month Medigap open enrollment period, which starts the first month you’re 65 or older and enroll in Medicare Part B. You generally get better prices and more choices among policies during this time, according to Medicare.gov. You may also be able to enroll at other times of the year, but keep in mind that you may have a limited number of plans to choose from, and they may cost more.

On the other hand, if you have a Medicare Advantage plan, you may opt to change your plan during the Medicare annual election period, which runs from Oct. 15 to Dec. 7 or the Medicare Advantage open enrollment period, which runs from Jan. 1 to March 31.

You can sign up for a Medicare supplemental insurance plan or Medicare Advantage plan online or by calling Medicare at 1-800-633-4227. (TTY users can call 1-877-486-2048, and the line is open 24 hours a day, seven days a week.) You can also explore theMedicare Plan Finder to see available plan options in your area.

Disclaimers

The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800- MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Not affiliated with or endorsed by any government agency.

Every year, Medicare evaluates plans based on a 5-star rating system.

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What’s the Difference Between Medicare and Medigap? originally appeared on usnews.com

Update 01/13/23: This story was previously published at an earlier date and has been updated with new information.

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