Medigap Plan F vs Medicare Advantage Plan

We are often asked if medicare supplement (medigap) plans and medicare advantage (MA) plans Comparing Apples to Orangesare the same.  Many of our clients are quite confused about these two and often mix the features and benefits of each.  Let’s start by stating that medigap plans and medicare advantage plans are NOT the same.  We are definitely talking about apples and oranges here.  If anyone tells you they are the same, run as fast and as far as you can from them!

 

ComparisonMedigap Plan FMedicare Advantage (MA) Plan
Medigap Plan FMedicare Advantage (MA) Plan
EligibilityMust be enrolled in Medicare Part A and B. All applicants must be accepted during Medigap Open Enrollment and Guaranteed Issue Periods.

Outside of this time insurance carriers can deny coverage and/or rate up the premiums based on health of member at time of application.
Must be enrolled in Medicare Part A and B and live in the service area of the provider. All applicants are accepted unless they have End Stage Renal Disease.
Costs
Premiums can vary on plan chosen, carrier, gender, and health.

Plan F covers 100% of Medicare approved medical expenses.
Members of the plan pay the same premium regardless of age, gender and health.
Typically you will have additional co-pays and coinsurance amounts for Medicare approved medical expenses. Many plans will have high annual out of pocket maximums.
Healthcare Provider OptionsThere is NO network. As long as your provider accepts Medicare they accept the plan regardless of the carrier. No referrals for specialist required.HMOs and PPOs are the most common provider networks.

HMO: Generally in-network coverage only. Will need referrals from primary provider for specialists. Can see out of network providers in a case of emergency.

PPO: No referrals needed. Covers out of network providers at a high rate. Plans have higher premiums but offer more flexibility.
Prescription CoveragePrescriptions are not covered.

You can enroll in any PDP (Prescription Drug Plan) of your choice.
Prescription coverage is most often included but you must make sure that it is an MA-PD (Medicare Advantage Prescription Drug) plan. Some carriers offer Medical only coverage, which does not included Part D.

Very important to make sure that your prescriptions are on the formulary (and how much will they cost) before finalizing this coverage.
Is the Plan Renewable?Yes as long as you continue to pay the monthly premium. Benefits never change. You will not be cancelled due to claims. You will not be singled out for rate increase due to claims. Rates are increased/decreased across the entire group that is enrolled in your carrier's plan.Insurance carrier determines benefits. Premiums, benefits, co-pays, networks, and max out of pocket limits can change yearly. If carrier cancels MA plan you are eligible to enroll in any other carrier's MA plan within 60 days.
What else is covered?Only original medicare. Some carriers give you a free gym membership through Silver Sneakers.Some plans include basic dental, vision, and preventive care. Some carriers give you free gym membership through Silver Sneakers.
When can I enroll or change plans?You can enroll when you start Medicare. You can enroll and dis-enroll at anytime (however you will likely be subject to underwriting/health question with new carrier).You can enroll when you start Medicare. You can only change plans during Annual Enrollment Period (AEP - Oct 15th thru Dec 7th) or if you qualify for a Special Enrollment Period (SEP).
Which one is best for me?Don't want to deal with co-pays and coinsurance amounts. Like the idea of having 100% coverage (Plan F) for Medicare approved claims, giving you $0 out of pocket exposure.

This plan is ideal for people that travel often or may live in another state for a period of time throughout the year.

Choice of any doctor anywhere you want (as long as they accept Medicare).
Main goal is to save on monthly premiums and understand the high out of pocket exposure of the plan.

If you don't live elsewhere during portions of the year and have access to doctors in the HMO or PPO.

Want a "packaged plan" that includes both medical and prescription coverage.

Although this an attempt to compare medigap plan F with a medicare advantage plan, we typically do not favor medicare advantage plans due to the many moving variables that make up a MA plan.  We like to look past this comparison and discuss how a health issue can affect each plan type over the long term.  In our experience Medicare advantage plans expose clients to much higher out of pocket expenses over time.  We have many referrals who come to us on Medicare Advantage plans who are desperately trying to get off of these plans.

Plan F sounds great doesn’t it!  However, we usually don’t recommend Plan F in most cases.  There is a better option than Plan F.  We believe it’s the best overall value for our clients. To find out what plan we do recommend the most, click this link (Comparing Plan F and Plan G) and we will show you why!