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Should I Get Medigap If I Have A Medicare Advantage Plan?

What Is Traditional Medicare?

Traditional Medicare is the government health care program offered to people who are retired, eligible to receive Social Security benefits, and are age 65 and over or determined to be 100% disabled by the Social Security Administration. Beneficiaries have the option to pay for a specific coverage, which is referred to as Part A (hospitalization) and Part B (Outpatient Care). Premiums must be paid for coverage, and beneficiaries do have the option to acquire a Medigap plan to supplement their traditional Medicare coverage.

What is a Medigap Plan?

A Medigap plan is a supplemental health care coverage specifically designed for beneficiaries who have traditional Medicare. It is sold and managed by private health insurance companies under the direction of the Centers for Medicare and Medicaid Services (or CMS), and strictly regulated by both federal and state laws. The Medigap’s primary purpose is to offer supplemental coverage for fees that are not covered by traditional Medicare. A premium must be paid to the hosting health insurance company in addition to your traditional Medicare monthly premium. Each type of Medigap plan is identical from company to company, therefore each private health insurance company chooses to provide which of the twelve (12) different types of Medigap coverage plans to sell. Still, prices for coverage vary from company to company. Beneficiaries need to determine which plan best fits their needs and budget and which company to get the plan from.

What About Medicare Advantage Plans?

Medicare Advantage (MA) plans can be visualized as Medicare’s version of a Health Maintenance Organization, or HMO. Rather than using the traditional Medicare with a Medigap supplemental plan, beneficiaries can opt to purchase a Medicare Advantage plan. MA plans are sold by private health insurance companies operating under the direction of CMS, and strictly regulated by both federal and state laws as well. Difference is beneficiaries must seek treatment from the health insurance company’s network of service providers (hospitals, doctors, specialists, laboratories, pharmacies, etc). Beneficiaries can purchase an MA plan that best caters to their needs and budget. Plans usually carry names such as Basic, Gold, and Platinum. Each individual plan offers a higher level of coverage and benefits for a higher premium. Some MA plans include free Medicare Part D coverage, which is the Prescription Drug Coverage program under Medicare. Beneficiaries with traditional Medicare and Medigap plans must pay an additional premium for Prescription Drug coverage, which might be offered by the same company providing the Medigap plan.

Why Get a Medicare Part D Plan?

As previously mentioned, Medicare Part D is the Prescription Drug Program for Medicare. Traditional Medicare does not cover prescription drugs, that is, drugs you would customarily get at your local pharmacy after you visited your physician. Needless to say, drug costs are getting higher but the Social Security payments remain just about the same. Whether you have traditional Medicare, a Medigap plan, or Medicare Advantage (MA) plan, the Prescription Drug coverage is always advisable to have. For an additional premium it can be acquired from private health insurance companies, who just might carry Medigap and MA plans as well.

So What About My Original Question?

So now that we have all the basics covered in a language all of us normal humans can understand, here’s the spill on “Whether An Medicare Advantage Plan Holder Should Get A Medigap Plan” to supplement costs that are not covered by their MA plan. Simple answer is no. The Medigap plans are specifically designed to supplement traditional Medicare coverage. If you have a Medigap plan and just joined an MA plan, you cannot use your Medigap plan to cover fees for services not covered by your MA plan. Now here’s the most important fact of this report. If you have a Medicare Advantage plan you cannot be sold a Medigap plan. As I mentioned, these plans are strictly regulated by both state and federal laws, which are customized to protect you, the beneficiary. I hope this report was informational and helpful. For more detailed information on these topics you can always access the Internet and go to WWW.Medicare.Gov. Unfortunately, it is written mostly in government jargon, so good luck, and I wish you health and happiness in the future.

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