What Is The Difference Between Medigap And Medicare Advantage?

What Is The Difference Between Medigap And Medicare Advantage?

Medicare Advantage plans are HMOs or PPOs offered by private insurance companies. They offer the same basic benefits as Original Medicare, but may offer additional benefits, like vision and hearing.

In contrast, Medicare Supplement plans are sold by private insurance companies. Medigap plans are standardized and are available in every state. A Medigap plan will cover the benefits not covered by Original Medicare.

What is the difference between Medicare Advantage and Medicare Part D?

Medicare Part D is a prescription drug plan available to all Medicare beneficiaries. Medicare Part D plans are an optional benefit under Original Medicare, and Medicare Advantage plans are HMOs or PPOs offered by private insurance companies.

See Medicare Part D: Learn More

How do I enroll in a Medicare Advantage plan?

Medicare Advantage enrollment is done through the carrier of your choice. If you are interested in finding out more about Medicare Advantage, you can call your local Medicare office to talk to a licensed insurance agent. To find your local office, call 1-800-MEDICARE (1-877-690-1012).

What if I already have a Medicare Advantage plan that I like?

You can stay with your current plan or change to a new one. You can change plans only during the open enrollment period from October 15 through December 7. The open enrollment period for Medicare Advantage plans is the same as for Original Medicare.

What if I can't afford the monthly premiums?

If you have limited income and resources, you can apply for Extra Help to pay for your Medicare Part D plan's monthly premiums and prescription drug costs.

What if I have vision or hearing problems?

Most Medicare Advantage plans and Medigap plans offer vision and hearing coverage. This coverage is not available in Original Medicare.

What is a Medicare Advantage Organization (MAO)?

A Medicare Advantage Organization (MAO) is an organization that contracts with Medicare to provide health care services to Medicare beneficiaries. Many MAOs offer health care plans under the name of an affiliated health maintenance organization (HMO).

How can I obtain more information about Medicare Advantage plans?

You can contact Medicare at 1-877-690-1012 or 1-800-MEDICARE (1-877-690-1012).

You can get more information about Medicare Advantage plans at www.medicare.gov or www.medicare.gov/part-d.

You can also get information from your local Independent Review Organization (IRO), which is an independent organization that is required to provide unbiased information about Medicare health and drug plans.

How can I obtain more information about Medicare Part D?

You can get more information about Medicare Part D at www.medicare.gov/part-d.

How do I file a complaint about a Medicare Advantage plan?

Call Medicare at 1-877-690-1012.

You can report a problem with an MAO or a Medicare Advantage plan to your state's Department of Insurance or the National Association of Insurance Commissioners (NAIC) at www.naic.org. The NAIC can help you understand your rights and how the problem can be resolved.

Can I switch from one Medicare Advantage plan to another Medicare Advantage plan during a plan year?

You can switch from one Medicare Advantage plan to another during a plan year if you meet certain conditions. Some of the plan year requirements are:

The plan year must have begun no less than 6 months and no more than 18 months prior to the month of change.

You must stay in the new plan for at least 12 consecutive months or until the plan year ends, whichever is longer.

You cannot change plans more than once during the plan year.

There are additional conditions that prevent you from changing plans, such as a waiting period for enrollment and preexisting condition clauses.

Can I switch from a Medicare Advantage plan to Original Medicare during a plan year?

You can switch from a Medicare Advantage plan to Original Medicare during a plan year if you meet certain conditions. Some of the plan year requirements are:

You must stay in the Original Medicare plan for at least 12 consecutive months or until the plan year ends, whichever is longer.

There are additional conditions that prevent you from changing plans, such as waiting periods for enrollment and preexisting condition clauses.

What if I don't enroll in a Medicare Advantage plan or Medigap plan?

If you don't enroll in a Medicare Advantage plan or Medigap plan, you will still be enrolled in Original Medicare. Medicare Advantage plans and Medigap plans are supplemental to your Original Medicare benefits. Visit www.medicare.gov for more information about Original Medicare.

What if I already have a Medicare Supplement plan?

Medicare Supplement plans are standardized and are available in every state. If you have a Medicare Supplement plan, you can stay in your current plan. If you have questions about your Medicare Supplement plan, you should call the phone number on your insurance card.

How can I get more information about Medicare coverage and rules?

Medicare has a variety of informational resources available. Some of the resources available include:

Visit www.medicare.gov to get more information about Medicare.

Call Medicare at 1-800-MEDICARE (1-800-

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