Which to choose, Medigap or Medicare Advantage?

Consumer Reports

Q. I'm turning 65 soon and going on Medicare. Which do you recommend, Medigap or Medicare Advantage?

A. This is probably the top question that comes to my mailbox. Unfortunately, there's no one-size-fits-all answer. As a community service, I'm providing this chart comparing the two options so you can decide for yourself.

But first, a reminder: No matter which way you decide to go, you must first be enrolled in Medicare Part A (hospitals) and Part B (doctors). That's non-negotiable.

 

Medigap

Medicare Advantage

How it relates to Original Medicare Parts A & B

Private supplemental coverage that pays all or most Part A & B deductibles and co-insurance.

Private health plan that provides Part A & B benefits directly in place of Original Medicare.

Premium

Average of about $150 to $200 a month. Can vary by age, health history, or both.

$0 to more than $100 a month depending on the plan. All plan enrollees pay the same regardless of age or health history.

Out-of-pocket costs

Low to none (not counting premium).

In-network medical deductibles and  copays of up to $3,400 to $6,700 a year, depending on the plan.

Choice of doctors and hospitals

Any that participate in Medicare.

HMOs: Plan providers only.

PPOs: Any provider,  but out-of-network providers cost more.

When you can buy

First six months after you sign up for Part B and are at least 65 years old. After that, in most states you can be turned down or charged extra for pre-existing conditions.

When you first enroll in both Medicare A  and B and annually thereafter during Open Enrollment (Oct. 15-Dec. 7).

Part D (drug) coverage

Not ibncluded. You must buy a separate Part D plan for this.

Most plans include a Part D add-on. If not you can buy a separate plan.

Quality information available

No.

Yes. Medicare.gov has star ratings (5 stars are the best). Consumer Reports has Medicare Advantage quality rankings from NCQA.

Cards in your purse or wallet

Three. 1. Red, white, and blue Medicare card. 2. Medigap card. 3. Part D card.

Usually just one Medicare Advantage card (two if you have a standalone drug plan). Red, white, and blue Medicare card can stay in your desk drawer.

Paperwork

Little to none. Medigap almost always automatically cuts a check to providers after Medicare pays its share.

Some, because you pay deductibles and copays directly to providers.

Got a question for our health insurance expert? Ask it here; be sure to include the state you live in. And if you can't get enough health insurance news here, follow me on Twitter @NancyMetcalf.

Health reform countdown: We are doing an article a day on the new health care law until Jan. 1, 2014, when it takes full effect. (Read the previous posts in the series.) To get health insurance advice tailored to your situation, use our Health Law Helper, below.



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