Medicare FAQs

What Is Medicare Supplement Insurance (Medigap)?

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like co-payments, co-insurance and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the United States. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs, then your Medigap policy pays its share..

What Is a Medicare Advantage Plan?

A Medicare Advantage Plan is different from a Medigap policy. Medicare Advantage plans provide specific Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” provide Part A and Part B coverage, and are offered by Medicare-approved private companies. Anyone on Medicare can choose to receive their Part A and Part B benefits through one of these private health plans instead of through original Medicare. Medicare Advantage plans now cover nearly 3 in 10 Medicare recipients. Most Medicare Advantage plans also include Part D prescription drug coverage.

What Do I Need to Know about Medicare Advantage Plans?

There are different types of Medicare Advantage Plans:

  • Health Maintenance Organization (HMO) plans—In most HMOs, you only can go to doctors, other health care providers or hospitals in the plan’s network, except in an urgent or emergency situation. You also may need to get a referral from your primary care doctor to undergo tests or see other doctors and specialists.
  • Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you use doctors, hospitals and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals and providers outside of the network.
  • Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers and hospitals, and how much you must pay when you get care.
  • Special Needs Plans (SNPs)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home or have certain chronic medical conditions.
  • HMO Point-of-Service (HMOPOS) plans—HMOPOS plans are HMO plans that may allow you to get some services out of network for a higher copayment or coinsurance.
  • Medical Savings Account (MSA) plans—MSA plans are a combination of a high-deductible health plan with a bank account. You set up an MSA with a bank that your plan chooses. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan.

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How Much Do Medicare Advantage Plans Cost?

In addition to your Part B premium, you usually pay another monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join.

What Do Medicare Advantage Plans Cover?

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the United States). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses or wellness programs. Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage. Plan benefits can change from year to year. Make sure you understand how a plan works before you join.

I currently have a Medicare Advantage Plan but am considering a Medigap policy for next year. Can I have a Medicare Advantage Plan and a Medigap policy?

If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.

I am 63 years old and retired. Can I purchase a Medigap plan?

Generally, you must have Medicare Parts A and B and live in the plan’s service area to be eligible to join. Insurance companies are not required to sell Medigap policies to people under 65, though some insurance companies may choose to do so anyway. Some states require insurance companies to offer at least one kind of Medigap policy to people under 65 who have Medicare.

My spouse and I are both on Medicare and are considering purchasing a Medigap plan. Can we purchase a family plan?

A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

My spouse and I are both relatively healthy but have recurring pharmaceutical needs. Can we purchase a Medigap plan with prescription drug coverage?

Some Medigap policies sold in the past covered prescription drugs, but Medigap policies sold after Jan. 1, 2006, aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can add on a Medicare Prescription Drug Plan (Part D).

I don’t have access to my union’s coverage anymore and am eligible for Medicare. What can I do?

You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.

Answers to the above questions provided by Consumer Reports and