October 15, 2018
What are the differences between MA plans and Medigap plans?
Medicare Advantage plans
- More out-of-pocket costs
- Works only in your state, by region or county
- Must use a provider network
- Most plans cover Medicare Part D
Medigap plans
- Fewer out-of-pocket costs
- Works in any state
- No provider network required unless you buy a Medigap Select plan
- Medicare Part D not included
Things to consider before you buy a plan
Ask your medical providers If they’ll take the MA plan.
Ask the plan if It requires a referral for you to see a specialist.
If you live in another state part of the year, find out if the plan will still cover you. Many plans require you to use regular services within the service area (except for emergency care), which is usually the county in the state where you live.
Find out if the plan includes:
- Monthly premiums
- Any copayments for various services
- Any out-of-pocket limits
- Costs to use non-network providers
If you have Medicaid or receive long-term care, or live in a nursing home, Special Needs Plans may be available in your area. If you choose other types of MA plans, find out if:
- The plan’s in-network providers you use are certified to accept Medicaid.
- In-network providers bill the plan correctly and/or refer to Medicaid providers as needed.
- The providers’ office knows what Medicaid covers and what the plan covers.
- You’ll have monthly premiums to pay. Medicaid will not cover MA plan premiums.