Medigap vs Medicare Advantage 2017

June 29, 2017 - 3 minutes read

Medigap and Medicare Advantage are both optional medical insurances that cover a wide range of services that Medicare don’t. A Medigap plan works in conjunction with Medicare and is designed to cover most of your out of pocket medical expenses. It is the gap which covers what Medicare doesn’t.

Medicare Advantage cover replaces Medicare cover, and also provides additional services.

If you have a Medicare Advantage insurance plan (Medicare Part C) you cannot have a Medigap policy also. Here are some of the differences between the two policies:


  • You must have Medicare Parts A and B insurance to take up a Medigap policy. This policy works side by side with Medicare. It provides a payment for the gap fees that Medicare does not cover.
  • Co-payments, co-insurance and deductibles are all covered
  • The 20% of hospital expenses that Medicare does not cover is covered by Medigap. Medigap will also cover an additional 365 days of hospital cover
  • Can provide emergency medical care when you travel overseas
  • Does not normally cover vision, dental, prescription drug coverage or long term medical care
  • You can go to any doctor that participates with Medicare
  • There is no maximum out of pocket limit
  • Medigap can have a higher premium than Medicare Advantage

Medicare Advantage (Medicare Part C)

  • Is in place of Medicare Part A and B. Medicare Advantage (Part C) plans offer all that is covered under Medicare (Parts A & B), except for hospice care
  • Benefits such as dental, vision and prescription drugs may also be covered
  • Has a maximum out of pocket annual fee. Once that limit has been reached there is no cost for covered services
  • You must live within the service area of the plan that you wish to enroll in
  • Covers
    • Doctor’s visits
    • Hospital stays
    • Home health care
    • Outpatient care
    • Hearing care
    • Wellness services
    • Nurse helpline
    • Prescription drugs in some policies
    • Extra benefits when bundled with the plan
  • Usually has lower premiums than Medigap

As you can see, there are a host of benefits for both plans. While Medigap is terrific for out of pocket expenses and hospital cover, it does not usually provide additional services. Always take into account your personal health situation and possible future needs.

Before starting a new policy or changing your policy speak to our knowledgeable team for professional advice. Contact us at AG Capital Insurance today for an obligation free assessment!