For starters, they’re both options for people with Medicare, but Medigap coverage supplements original Medicare, while Medicare Advantage is a private insurance alternative to federally run Medicare. They’re very different, and their unique types of coverage can’t be combined.
Only those enrolled in original Medicare, which includes Part A hospitalization and Part B doctor and outpatient care, can purchase Medigap, also called Medicare supplement insurance. People choose to purchase Medigap to pay for some of the health care costs that Medicare does not. While it’s not government run, federal rules standardize Medigap, also sold through private insurers, to cover out-of-pocket Medicare expenses, such as deductibles and copayments.
Medigap insurers can offer up to 10 different plans, each labeled with a letter. See the table below for details. Plans with the same letter include the same benefits, even if different insurance companies offer them, but the premiums can vary widely.
What Medigap plans cover in part or in whole:
- 20 percent Part B coinsurance for physician visits and other outpatient services.
- Part A daily coinsurance for days 61 to 90 in the hospital for each benefit period; $400 a day in 2023.
- Part A daily coinsurance for up to 60 lifetime reserve days; $800 a day in 2023.
- Up to 365 additional days in the hospital in your lifetime after Medicare benefits are used up.
- First three pints of blood.
- Coinsurance costs for hospice care.
Some Medigap plans also cover:
- Part A hospital deductible; $1,600 per benefit period in 2023.
- Coinsurance costs for skilled nursing facility.
- Foreign travel emergencies.
You can go to any doctor who accepts Medicare — Medigap will fill in the gaps. But Medigap doesn’t cover prescription drugs, so if you have traditional Medicare and want drug coverage, you’ll need to get a stand-alone Part D prescription drug policy.
How and when should I shop for a Medigap policy?
You can buy a Medigap policy anytime you have Medicare Part A and Part B. This insurance doesn’t have an open enrollment period during certain times of the year, like Medicare Advantage and Part D plans do.
But Medigap insurers can reject you or charge more if you have preexisting conditions unless you buy a policy during certain times, such as within six months of enrolling in Medicare Part B if you’re 65 or older. Medigap insurers must also offer you a policy regardless of preexisting conditions in other situations, such as if you were enrolled in a Medicare Advantage plan but moved outside of the plan’s service area.