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Medicare Supplement Vs. Medicare Advantage
Considering Medicare Advantage Or Medicare Supplement
Millions of Americans aged 65 and older are enrolled in Original Medicare, which covers inpatient hospital costs (Part A) and outpatient medical costs (Part B). But for a growing number of people, Original Medicare is not enough.
To get the additional coverage to meet their needs, many turn to Medicare Supplement (Medigap) and Medicare Advantage (Part C) plans. Both plans can help lower out-of-pocket costs, plus Medicare Advantage offers benefits not included in Original Medicare.‡
The following key differences and considerations can help you decide whether Medicare Supplement vs. Medicare Advantage is right for you.
Medicare Supplement (Medigap) Vs. Medicare Advantage
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Features And Considerations
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Medicare Supplement
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Medicare Advantage (Part C)
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Consider if …
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You want to supplement Original Medicare‡ to control costs. |
You want an all-in-one healthcare plan with additional benefits.
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Key Features
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Helps pay for copays, deductibles, and coinsurance for Original Medicare‡
Part A:
Part B:
Does not cover:
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Combines Original Medicare‡ with routine Dental, Vision, and Hearing coverage.
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Cost Considerations
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Your monthly premiums may be higher compared to Medicare Advantage, but your annual out-of-pocket costs may be lower.$137 - $2664Monthly Premium RangeHelps cover copays, coinsurance, and deductibles, so your costs are more predictable.
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These plans protect you with yearly limits on your out-of-pocket costs for medical and hospital care.
$18Average Monthly Premiums
With copays3
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What Is Medicare Supplement (Medigap)?
As the name suggests, Medicare Supplement, also known as Medigap, supplements Original Medicare‡ to help pay for out-of-pocket costs like deductibles, copays, and coinsurance.
To help you decide whether Medicare Supplement is the right fit for you, here are some tips, features, and factors to consider.
Scenarios For Choosing Medicare Supplement
You travel or live in different locations in the U.S. throughout the year
You want the freedom to choose any doctor or hospital the accepts Medicare patients
You prefer not having to get referrals to see specialists
You don't mind adding separate plans to cover prescription drugs, dental, and vision coverage
Coverage Details
As noted, a Medicare Supplement plan helps to pay for Original Medicare‡ deductibles, copays, and coinsurance, but doesn’t cover prescription drugs, dental, vision, or hearing care.
Plans are standardized by the federal government, like these offered by Anthem:
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Plan A
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Basic coverage, lower premium, deductible for hospital care
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Has the most comprehensive coverage of Original Medicare‡ costs. Limited to those eligible for Medicare prior to January 1, 2020
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Broadest coverage for those newly eligible for Medicare. Covers all Original Medicare‡ costs except the Part B deductible
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Lower premium, some copays, small annual deductible
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Anthem offers extras like prescription savings, discounts on vitamins and weight loss programs, and SilverSneakers® fitness memberships.
Enrollment Factors
Need Original Medicare‡ Parts A and B to enroll.
Best time to enroll is your Initial Enrollment Period, starting three months before you turn 65, and ending three months after the month you turn 65.
You also can enroll during the Medigap Open Enrollment period, starting the first month you have Medicare Part B and you're 65 or older.
If you sign up during your Initial Enrollment or Medigap Open Enrollment Periods, you can't be denied coverage or charged higher premiums even if you have pre-existing health problems.
If you enroll later or switch from a Medicare Advantage to a Medicare Supplement plan, you could be denied coverage based on pre-existing health conditions.
Costs
You'll have low or no copays when you get care. You may pay higher monthly premiums, but your out-of-pocket costs will be stable.
You'll need to continue to pay your Medicare Part A and Part B premiums. Part A is $0 for most people.
What Is Medicare Advantage?
Medicare Advantage plans have comprehensive coverage with $0 or low monthly premiums.
The following scenarios and details can give you additional knowledge and confidence when considering Medicare Advantage (Part C) plans.
Scenarios For Choosing Medicare Advantage
You want a low monthly premium combined with a single all-in-one plan, along with the ease of dealing with a single insurance company.
Your doctor is in-network, and your prescription drugs are covered by Medicare Advantage.
You want to upgrade your current Medicare Supplement plan but were denied due to a pre-existing condition. With Medicare Advantage, you can't be denied for health reasons.
Coverage Details
As noted, Medicare Advantage plans provide comprehensive coverage for hospital and medical care, along with routine dental, vision, and hearing care. Most plans also include Prescription Drug (Part D) coverage.
Choose Between A Health Maintenance Organization (HMO) And A Preferred Provider Organization (PPO).
Health Maintenance Organization: Lower premiums and copays, but require in-network doctors, and some require referrals to see specialists
Preferred Provider Organization: Higher premiums and copays, but you can see out-of-network doctors, with no referrals for specialists
Make sure your doctor is in-network if you choose an HMO plan. Even if you choose a PPO with out-of-network coverage, your costs will be lower if your doctors are in-network. Also, check to ensure your prescription drugs are included before choosing your Medicare Advantage plan.
Special Needs Plans (SNPs) provide support, benefits, and coverage for those who qualify based on chronic medical conditions or low incomes.
Anthem offers other benefits, including spending allowances for over-the-counter health items, groceries, utilities, transportation, and more, as well as SilverSneakers® fitness memberships. (Benefits may vary based on plans, locations, and individual conditions.)
Enrollment Factors
You'll need Original Medicare‡ Parts A and B to enroll. Here are key details about when to enroll.
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Initial Enrollment Period
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Annual Enrollment Period
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Medicare Advantage Open Enrollment Period
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Special Enrollment Period
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Most people enroll during the Initial Enrollment Period, which includes the three months before the month of their 65th birthday through the three months after their 65th birthday.
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October 15 to December 7
You can shop, switch, and drop Medicare plans during this period.
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January 1 to March 31
Allows you to change your Medicare Advantage plan once if you're not happy with the plan you chose during the Annual Enrollment Period.
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If you have a qualifying life event, like moving out of your plan's service area or losing coverage via your employer.
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‡Original Medicare: Part A (Hospital Insurance) and Part B (Medical Insurance)
1Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
2Source: Journal of the American Medical Association Open Network https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799376
4Medicare Supplement Plan G for a 65-year-old non-smoker in California. Source: Explore your Medicare coverage options (accessed June 2023) Medicare.gov .
Anthem Blue Cross is an HMO plan with a Medicare contract. Anthem Blue Cross Life and Health Insurance Company is an LPPO plan with a Medicare contract. Anthem Blue Cross is an HMO SNP plan with a Medicare contract and a contract with the California Medicaid program. Enrollment in Anthem Blue Cross, Anthem Blue Cross Life and Health Insurance Company depends on contract renewal.