Choosing between a Medigap Plan (also known as a Medicare Supplement) and a Medicare Advantage Plan Prescription Drug Plan (MAPD) is one of the most important decisions you’ll make when you turn 65 – or when enroll in Part B (when you leave group coverage).
A Medigap Plan supplements Original Medicare (known as Medicare Part A & Part B). In simple language, Original Medicare pays 80% of your medical costs and you pay the remaining 20%. Most importantly, there is no cap on the 20% – medical bills could quickly add up. Therefore, when getting on Medicare for the first time, most people choose between Original Medicare plus a Medigap Policy or a Medicare Advantage Prescription Drug Plan.
Choosing one over the other is one of the most important choices you will make when turning 65. The choice you make will impact your health needs now, and in the future. Below is a breakdown of each type of plan:
Medigap Policy:
With this choice, an individual will have Original Medicare plus a Gap Plan (or Supplement) plus a Drug Plan. Currently, Plan G is the most comprehensive plan available. If you enroll in Plan G your only out of pocket cost for covered expenses is $257 for plan year 2025. You may see any doctor or use any facility in the US that agrees to bill Medicare. Additionally, there is very little need for prior authorization and very few claim denials. These plans do come with a monthly premium.
The plans do not cover Dental, Vision or Hearing, so if you want these benefits you would need to purchase additional coverage.
Medicare Advantage Prescription Drug Plan:
When choosing a MAPD It is important to understand you are enrolling in a managed care plan which is like traditional insurance. You have the option of choosing to enroll in plan with an HMO or PPO network. Most plans have a $0 monthly premium; however, you must continue to keep Medicare Part A & Part B. Enrolling in a MAPD will replace traditional Medicare. The MAPD will be billed, not original Medicare. You are responsible for your share of covered costs, such as copays and coinsurance. It is more of a “pay as you go” type of plan. These plans frequently come with dental, vision, hearing and other benefits.
Here is the catch:
Typically, you can enroll in a Medigap Plan with automatic approval only when you turn 65, or enroll in Part B. You have six months after the effective date of your Part B to enroll in a Medigap Plan. If you wait beyond that window of time, you must go through medical underwriting, and you can be denied coverage. Most people wrongly assume they can transfer back and forth between any plan during the Annual Enrollment period and that simply is not true.
Making the right choice for your needs and your budget is very important when you enroll in Medicare. Please talk to a licensed Medicare agent who represents multiple carries. I am a licensed Medicare agent. You can reach out to me at 970-465-2467 or lbooty@lb-ins.com.
