The Modern Medicare Agency Blog
Medicare Advantage Plan (or “Plan C”) and Medicare Supplement Insurance (or Medigap) are both healthcare subsidies. They shoulder expenses not covered by the Original Medicare plan. However, despite having the same functions, they differ in their coverage and qualifications for eligibility. Here are their similarities and differences.
What Healthcare Costs Do Each Cover?
Medicare Plan C and Medigap cover expenses that are not part of Plans A and B. However, Plan C compensates for costs under the Original Medicare plan, except hospice care. It also shoulders prescription expenses under Plan D and emergency and urgent health support. Lastly, it reimburses for costs under eye care, hearing, and dental services.
Meanwhile, Medigap compensates for other costs, including coinsurance, copays, and deductibles. However, deductibles under Plan B are not covered for newly-enrolled Medigap beneficiaries starting on January 1, 2020.
Who is Qualified for Each Healthcare Plan?
Another distinction to point out is the qualifications for each healthcare plan. The following are the considerations for eligibility for either of the two insurance plans.
Beneficiary’s Existing Medicare Plan
Since Plan C or Medigap covers the Original Medicare plan, those who wish to enroll in either of the two should have enrolled in Medicare Plans A and B. One should not have both Plan C and Medigap in their healthcare plan.
Geographical or Service Area Coverage
Plan C beneficiaries should live within the plan’s service area as determined by the healthcare provider. It includes the doctors and the hospitals you may want to go to for urgent medical support and regular check-ups. On the other hand, Medigap can be obtained by beneficiaries regardless of their service area as it is covered nationwide.
Age and Condition of Beneficiary
Medicare Plan C and Medigap only accept people over 65 years of age as beneficiaries of their plans. However, they also allow people below 65 years of age but have existing disabilities. Those with end-stage renal disease are not eligible for Plan C but can acquire supplementary insurance, such as Medigap.
Medicare Advantage Plan and Medicare Supplement Insurance shoulder healthcare costs not covered by the Original Medicare plan. However, these are two different services, and one should examine whether the coverage applies to their condition and circumstance.
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