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COMPARISON CHART - Medicare Advantage vs. Medigap


comparison chart- Medicare Advantage vs. Medigap

 

 

Comparison

Medicare Advantage

Medicare Supplement

Eligibility:

Must have Parts A and B, and live in service area. Takes all applicants except those with End Stage Renal Disease (some exceptions).

Must have Parts A and B. Usually companies may deny, but must accept all applicants, all ages, during Medigap Open Enrollment and Guaranteed Issue periods.

Costs:
(Premium, co-pay, coinsurance,

out-of-pocket max)

All plan members pay same premium regardless of age, gender or health. Cost sharing (co-pays) must be paid for most medical services. Many plans have an out-of-pocket annual maximum.

Premium varies with gender and health and goes up with age. Companies may underwrite (add to premium). Generally, no co-pay costs at time of service. No out-of-pocket maximum.

Provider choice and availability:
(Always ask your providers what insurance they accept!)

HMOsand PPOs maintain provider network; they must have available providers in order to accept new members.

PFFS has no provider network; it may be hard to find providers who accept it in some areas.

HMO: Generally covers in-network only. Referrals may be required for specialist visits.

PPO: Covers out of network, but then costs may be higher. No referrals required.

No network:Go to any provider that accepts Medicare. No referrals required for specialist visits.

May be hard to find providers accepting Original Medicare in some areas.

May be used for treatments at major medical facilities, such as Mayo Clinics, OHSU, etc

Prescription drug coverage:
(Make sure your choice

Covers your Rx!)

If you want Rx coverage, you must enroll in the included Rx coverage if choosing an HMO or PPO. (VA-eligible excepted.)

With PFFS, you may choose either the plan's Rx coverage, if offered, or a stand-alone PDP.

Not included. If you want Rx coverage, you may enroll in any stand-alone (PDP) plan available.

Renewable:

No, benefits may change yearly. However, you usually remain in a plan unless you disenroll at election times.

Yes, guaranteed renewable as long as you pay the premium and the application was correct. Benefits never change. No election season for Medigaps.

Extras:

Some plans include routine dental, vision, or physicals. Some offer additional alternative medicine package.

Covers only same as Original Medicare. No routine dental, vision, or physicals; no alternative medicine.

Whom it may be best for:

Network plans may be good for people who otherwise can't find a Medicare provider. May save money unless you need frequent appointments or treatments.

Having a packaged plan may simplify choices.

Good for travelers or "snow birds". May save money for people needing high-cost or frequent care. Customize elements of your Medicare picture-choose doctors and drug plan.

How to comparison shop:

 

Plans are not standardized -use comparison pages at www.medicare.gov. Plans are regulated by Medicare/CMS

Because Medigaps are standardized, price and customer service are the only difference. Try calling a few competitively priced plans.

 

(Medicare Advantage vs. Medigap Comparison Charton eHealth Medicare)

Source of chart: Oregon.gov DCBS SHIBA




 
   
 


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