Medicare: What’s the Difference Between Advantage Plans and Medigap in CT?

Healthcare can be costly, especially for aging people. Setting aside a budget for extra medical costs can be challenging. Therefore, people are encouraged to enroll in Medicare, a government-sponsored health…

March 13, 2023

Written by Trey Bongiovanni

Healthcare can be costly, especially for aging people. Setting aside a budget for extra medical costs can be challenging. Therefore, people are encouraged to enroll in Medicare, a government-sponsored health insurance program, when they turn 65. If you’re already a Medicare beneficiary, you probably realized that it doesn’t cover everything. However, you might not know there are ways to supplement your Medicare coverage, like with a Medicare Advantage plan or Medigap policy in Connecticut. Keep reading to learn more about these two types of coverage and how they differ.

What’s Medicare?

Medicare is a mostly fee-for-service insurance program for people over 65 or with specific disabilities. It has four different parts. Part A covers inpatient bills, while Part B covers outpatient. Part C is an alternative to Parts A and B, called Medicare Advantage, that can offer additional benefits, and Part D covers drug prescriptions.

 

Private insurers approved by Medicare offer Part C (or Advantage) plans. They’re optional and usually cost extra. But they might save you money if you use many medical services. You can choose from a broad range of Advantage plans, including health maintenance organizations (HMOs), private fee-for-service (PFFS), preferred provider organizations (PPOs), and special needs plans (SNPs). However, not all plans will be available to all insurance providers.

Medicare Advantage Eligibility and Enrollment Periods

To enroll for a Medicare Advantage plan, you must be either 65 or older, young with a disability, or have end-stage renal disease. And most importantly, you must also have Part A and B coverage.

 

There are established periods for registering for either of the plans. The initial enrollment period is three months before and after your 65th birthday. The second window open for registration is October 15 to December 7 every year. You can switch from Original Medicare to a Medicare Advantage plan or from one Advantage plan to another during these periods. From January 1 to March 31, you can change Advantage plans or disenroll and return to Original Medicare. However, you can’t join a new Advantage plan.

Medicare Advantage Costs

As with Medicare Part B, you’ll have to pay a monthly premium for your Advantage plan. The price will depend on the insurer and the specific plan you choose. You might also have to pay extra costs, like a deductible or copayments. Sometimes, you might not have monthly premiums, but you’ll still be responsible for other out-of-pocket expenses.

What’s Medigap?

Medigap is also referred to as Medicare Supplement. Private companies offer them, and they help fill the gaps in Medicare. You can choose from 10 different Medigap plans with standardized coverage. These plans mainly help in paying deductibles, copays, and coinsurance. They don’t cover prescription drugs. In addition, Medigap only covers an individual, so you and your spouse will need separate policies.

Medigap Eligibility and Enrollment Periods

Having a Medigap plan also requires you to enroll in Part B. You must sign in within six months of turning 65 years or older. For example, suppose you’re born in April and turn 65 and enroll for Part B in April. In that case, your enrollment period is from April to September. If you don’t enroll in Part B during this window, there’s no guarantee that you can get a Medigap policy later. The insurer might charge you more, request your medical history, or make you wait for coverage to start.

Medigap Costs

As we mentioned, policies identified by the same letter must offer the same coverage, regardless of the company selling them. However, insurers can charge different prices. They can use three pricing methods:

 

  • Community Rating: The company charges the same price to everyone, regardless of health status or age. 

 

  • Issue-Age Rating: The company calculates your premium based on how old you are when you buy the policy. Usually, this results in lower premiums for younger enrollees. 

 

  • Attained-Age Rating: The company charges more as you get older. Under this system, your premium might start low but increase every year as you age.

 

The price is one of the deciding factors when choosing a Medigap policy. It can range greatly depending on your age, location, tobacco use, and whether you choose an HMO or PPO plan.

Which Health Coverage Option Should You Choose?

The best way to decide is to understand your healthcare needs and budget. If you need extra coverage for dental, vision, or prescription drugs, then Advantage plans might be the better choice. But if you want more flexibility in choosing your doctors and hospitals, Medigap might be better. Also, if you want to keep your current doctor, ensure they’re part of the network before enrolling in an Advantage plan.

Choose the Right Plan with the Help of Nesso Senior Benefits

Before settling on a plan, you must research and understand the different options available to you. At Nesso Senior Benefits in Connecticut, we can simplify the process and help you step by step. We can assist you in choosing the proper Medicare Advantage or Medigap plan for your needs and budget. Our team has decades of accumulated knowledge and experience in the industry. We’ll provide you with all the resources you need to make an informed decision about your coverage. Contact the Nesso Group today.

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