Choosing a federal health insurance program and signing up for it can be a confusing task for most people who don’t understand the differences between Medicare and Medigap. This task would depend on what sort of health care the elderly person requires. For example, will the insurance program cover hospital stays as well as prescription drugs? What is the cost advantage of one program over the other and what are some of the features to consider when choosing between them?
Understanding Medicare and Medigap
Medicare consists of four components: the standard health care plan comes with hospital insurance (Part A) and health insurance (Part B). Medicare Advantage is the Part C which is the substitute to the standard Medicare plan with additional advantages like coverage of prescription drugs. For people who choose not to purchase Medicare Advantage, there is always Part D which is prescription drugs coverage.
Medigap, on the other hand, allows to cover the services that are missing in the Medicare plan. These missing aspects can include copayments at the healthcare office and other hospital costs that are not covered in the standard Medicare. Since Medigap is private health insurance, there are many insurance companies offering 10 different types of plans with varying benefits. However, the important thing to understand is that the premium for all of these plans will also differ based on the benefits offered and will be separate from the standard Medicare program premium.
In order to purchase the Medigap plan, you must already have Parts A and B of Medicare. In addition, Medigap plan is used to supplement the traditional Medicare plan and Medicare Advantage is a substitute for Medicare plan which is why a Medigap plan cannot be used in conjunction with Medicare Advantage.
Benefits of Medicare Advantage versus Medigap
For a lot of people, choosing Medicare Advantage may sound like a reasonable deal for the following reasons:
However, while the monthly premiums under Medicare Advantage may be lower than Medicare, any possible out-of-pocket expenditure may be a lot higher. In addition to this caveat, another important aspect to keep in mind before buying Medicare Advantage is the fact that this plan will require you to go to only in-network providers, charging much higher copayments for out-of-network providers. In order to see a specialist, you may also need a referral from your primary doctor and this may also be more expensive.
Medigap offers some solutions to the issues in Medicare Advantage and it might make for a better option if you can afford to pay just a little bit more:
According to the federal rules, all people have about six months after they turn 65 to enroll into a health insurance plan. Whether you choose Medicare Advantage or Medigap, the important thing is to comprehensively explore the programs, take advice from providers, and speak to neighbors and friends who may have had some experience with both types of insurance programs.