KBenefits Insurance Services
Supplements and Advantage Health Plans

Differences Between

Medicare Supplements and Medicare Advantage Health Plans

Medicare Supplement – Medigap
Original Medicare

Part A & B

Medicare Advantage Health Plans

Part C

* No referrals to a specialist


* Your health plan may require referrals


* National access to all hospitals in America and  93% - 95% of providers in America accept Original Medicare A &B.

* Limited to carrier-network specific doctors and hospitals. Plan networks may include NJ-only access, regional access, multi-state or national access depending on the plan’s network.


* Annual Part B Deductible of $226 (2023).

* Then coverage at 100%.

* Max-out-of-Pocket is $226 per year.

* Plans can have copays, deductibles and/or coinsurance with a max out-of-pocket of ~$5,000 to ~$9,000 per year, in-network.


Drug Coverage:
* Enroll in a separate Part D Drug card.

* You can change plans every Annual Enrollment.

Drug Coverage:

* Drug coverage is included in an MAPD.
* To change your drug coverage, you will have to change your medical plan entirely.


* Plans range from Plan A to N.

* Based on age and gender.
* Age 65 rates range from $100-$150/month.


* Plans vary from carrier to carrier.
* Plans range from HMO, POS & PPO.
* Age 65 rates range from $0-$120/month.

Changing Coverage:
* Medical underwriting is required to change carriers. Carriers may allow you to change plans within their carrier.

* You can switch to Medicare Advantage (Part C) from Original Medicare A & B during the Medicare Annual Enrollment Period.

Changing Coverage:
* You can change your MAPD health plan or move to another carrier yearly upon Annual Enrollment.


* Once you enroll in an Advantage Health plan - MAPD, medical underwriting is required to switch to a Medicare Supplement with Original Medicare A & B.

What's The Difference?

 Medigap vs MAPD?

  • Medicare Supplements are also known as "Medigap plans".
  • MAPD: Medicare Advantage health plans with Prescription Drug coverage

Provider & Hospital Networks:

  • Medicare Supplements - Nationwide coverage
    - All hospitals nationwide accept medicare supplements.
    - About ~93% of providers nationwide accept medicare supplements.

  • MAPD provider networks vary carrier to carrier, plan to  plan. 
    - Out-of-state access may not be available with some plans.
    - Regional access and national access plans are available.

Plan Benefits:

  • Medicare Supplements:  Plan benefits are standardized by the government.  Private carriers are required to offer the same plan benefits as the Plan indicates.  ie.  Plan G is the same at any carrier.  All Medicare supplements use providers that accept Original Medicare.
  • MAPD:   Plan benefits vary carrier to carrier, plan to plan.  Plan benefits as well as provider networks can change upon annual renewal.  Plans can be discontinue upon renewal allowing you to select a new MAPD.

Prescription Coverage:

  • Supplements do not cover prescription.  Medicare Part D prescription coverage is use to help with the cost of your prescriptions. Plans, formularies and preferred pharmacies vary carrier to carrier but adhere to standardized plan requirements.
  • MAPD:   Medicare health plans have prescription coverage "built into" the health plan. So when you are considering your health plan choice you have to make sure the prescription plan also covers your medication costs.  If you want to change your prescription plan, you would have to change your MAPD plan.


  • Medicaer Supplements:  (Higher premiums) - There is usually a higher monthly premium.
  • MAPD:  (Lower premiums) - Premiums are usually lower.

Out Of Pocket Expeneses:

  • Supplements:  (Lower)  Low deductible then Medicare A & B is covered at 100%.
  • MAPD:   (Higher)   OOP expenses include:  copays, coinsurance, deductibles. 
    Your will incur expenses until you reach your maximum out of pocket.


  • Supplements: Once you enroll in a medicare supplement you can change carrier if you are approved by medical underwriting.
  • Part D prescription plans:  You can change your Part D Rx plan each year during Anuual Open Enrollment, Oct 15th thru Dec 7th.  Your new plan would start January 1st.
  • MAPD:   You can change your Medicare health plan every year during Annual Open Enrollment Oct 15th thru Dec 7th.  Your new plan would start January 1st.

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Christopher S. Kudryk
Insurance Specialist

KBenefits specializes in health, dental, vision, life and medicare insurance for employers and individuals in NJ & NY.

Thank you for your referrals!
Referrals are the cornerstone of our business.  Let us know if we can be of further assistance to you or someone you know.  Glad to be of service

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