Medicare Advantage vs. Medigap, in plain English

Before I started helping my parents, I didn't know the difference between Medicare Advantage and a Medicare supplement. I nodded along like I did. I didn't.

Here's the version I wish someone had given me.

First, the starting point. Original Medicare is the government plan. Part A covers hospital stays. Part B covers doctors and outpatient care. It doesn't cover everything, so most people add one of two things.

Option 1: Medicare Advantage (also called Part C)

• A private insurance company runs your Medicare for you.
• Premiums are often low, sometimes $0.
• Many plans include extras like dental, vision, or gym memberships.
• You usually have to use the plan's network of doctors and hospitals.
• Some care needs approval from the plan first.
• There's a yearly cap on what you pay out of pocket.

Option 2: Medigap (also called a Medicare supplement)

• You keep Original Medicare, and the Medigap plan helps pay what Medicare doesn't.
• You pay a higher monthly premium.
• You can see any doctor or hospital that takes Medicare, anywhere in the country.
• Your costs are more predictable.
• You buy a separate Part D plan for prescriptions.

The part nobody told me

Your best chance to get Medigap is when you first sign up for Medicare. After that, in most states, a Medigap company can ask about your health and turn you down or charge you more. So if a parent picks Medicare Advantage now and wants to switch to Medigap later, it may not be possible.

Questions to ask when you're choosing

• Are their doctors and hospitals in the plan's network?
• Do they travel or spend winters somewhere else?
• Would they rather pay more each month and have fewer surprises later?

Free help exists. Every state has a SHIP program (State Health Insurance Assistance Program) with trained counselors who explain Medicare at no cost. They don't sell anything.

Let's figure this out together.

I'm not a lawyer or financial advisor. This is what I've learned as a daughter going through it. Check the details for your own plan and state.