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Bobby Brock Insurance discusses the cost of Medigap and Medicare Advantage

Medicare Advantage and Medigap: How Are Costs Determined?

By now, you know that choosing health insurance is a critical decision. You have several options when it comes to Medicare coverage. Since Original Medicare — parts A and B — doesn’t cover everything, there are additional plans that you can add to fill in the coverage gaps. If you want additional Medicare insurance, you have to pick either Medicare Advantage or Medigap.

What Is Medicare Advantage?  

Medicare Advantage is an alternative to Original Medicare. There are different types of advantage plans that offer Medicare Part A (hospitalization), Part B (medical), and sometimes Part D (prescription drug) benefits. Depending on which program you choose, your plan may also cover dental, vision, hearing, gym memberships, and transportation to doctor’s appointments.  

What Is Medigap Insurance?

Medigap, or Medicare Supplements, is a different group of plans that help pay out-of-pocket expenses and items that your Original Medicare plan doesn’t cover — such as copayments and coinsurance. You can buy a Medigap policy along with your other Original Medicare insurance (Parts A, B, or D).  

Related Post: Medicare Advantage or Medicare Supplements: Which Is Better?

Eligibility Requirements

There are many requirements you need to meet to be eligible for Medicare Advantage or Medicare Supplements. Here’s how to know if you qualify:

Medicare Advantage Eligibility

  • If you’re enrolled in Parts A and B.
  • You qualify for Medicare Parts A and B if you’re 65 or older, have disabilities, or have ESRD.

Medicare Supplement Coverage Eligibility

  • If you’re enrolled in Original Medicare (Parts A and B)
  • You’re not already signed up for Medicare Advantage
  • You meet your state’s requirements for supplemental insurance

Cost of Medicare Advantage vs. Medigap 

You can buy Medicare Advantage, or Part C, through a private provider. The costs of each program are set differently. Let’s take a look at how carriers determine the premiums and fees. 

Medicare Advantage Cost

Like other insurance plans, Medicare Advantage premiums vary — depending on the provider you decide to enroll with and the program you choose. Some plans have no monthly premium, while others charge hundreds of dollars. However, the chances that you’ll pay more for your Part C than your Part B coverage are slim.  

Also, copay and deductible costs will vary by plan. To determine the potential costs for your plan, it’s best to compare plans carefully while shopping. An agent at Trusted Senior Specialists can help you with this.  

Other variables that may impact the cost of Medicare Advantage programs include:

  • Which plan you pick
  • How often you want to access medical services
  • Where you get your medical care — in or out of network
  • Your income — which may determine your premium, deductible, and copays amount
  • Whether you have financial aid like Medicaid or disability insurance

Related Post: How to Choose the Best Medicare Advantage Plan

Medicare Supplement Cost

Again, every insurance plan differs in price — based on your eligibility and the kind of coverage you want. With Medigap plans, the more coverage you need, the more you’ll pay. Also, the older you are when you sign up, the higher your premium may be.

Medicare.gov has a tool to help you compare Medicare Supplement rates. You can also work with an agent at TSS. We help our clients compare Medigap plans from multiple carriers — in your area — to get you the best rate.   

Variables that may impact the cost of your Medicare Supplement insurance include:

  • Your age (a 78-year-old who applies will pay more than a 67-year-old, for example)
  • the plan you select
  • Whether you qualify for a discount — female, nonsmoker, etc.
  • Your deductible — a plan with a higher deductible might cost less 
  • When you bought your plan — rules may change, and an older plan may be cheaper

Need Help Choosing a Medicare Plan?

Costs and eligibility are two big factors that influence your decision. If you’re deciding between Medicare Advantage and Medicare Supplements, or you’re set on one but need help choosing a specific plan, we can help. Call (855) 952-1941 to speak with a licensed insurance agent.