KBenefits
Medigap vs. MAPD

Medicare Supplements vs Health Plans

What's The Difference?

 Medigap vs MAPD?

  • Supplements are known as Medigap plans
  • MAPD known as Medicare Advantage Health plans, also referred to as Medicare Part C.

Provider & Hospital Networks:

  • Supplements:  All hospitals and ~95% of providers in America accept medigap plans.
  • MAPD provider networks vary carrier to carrier, plan to  plan.  Doctor and provider networks can be limited to just NJ access or a regional.  Out of state access may not be available.

Plan Benefits:

  • Supplements:  Plan benefits are standardized by the government.  Plan benefits are the same carrier to carrier.  ie. Plan G has the same benefits as AARP or Aetna.
  • MAPD:   Plan benefits vary carrier to carrier, plan to plan.  Plan benefits can change upon annual renewal.  Plan can be terminated or discontinue upon annual renewal.

Prescription Coverage:

  • Supplements:  No prescription coverage.  You can purchase a standalone Medicare Part D prescription plan from one of the private carriers.  ie. humana, wellcare, aarp
  • MAPD:   Prescription coverage can "built into" the health plan.  However, you can not elect a different prescription card.  You must take the prescription benefit that comes with the health plan..

Premium:

  • Supplements:  (Higher) There is usually a higher monthly premium.
  • MAPD:  (Lower)  Premiums can be lower. Some carriers offer zero premium plans.

Out Of Pocket Expeneses:

  • Supplements:  (Lower)  Usually you will have significantly less out of pocket expenses.
  • MAPD:   (Higher) Your annual max out of pocket can be as high as $7,100 for In-network services.

Flexibility:

  • Supplements: You can change your Medigap policy during the year if you are approved by medical underwriting.  Part D prescription plans can be changed each year without medical questions. during Anuual Open Enrollment, Oct 15th thru Dec 7th.
  • MAPD:   You can change your MAPD every year during MA OEP (1/1 thru 3/31) with no medical questions asked.  However, to move to Original Medicare (and Medigap policy), medical questions are asked and the carrier can deny your request to enroll based on medical history.

KBenefits, LLC
Christopher S. Kudryk
Call:  732-333-1976
Fax:   732-444-5971
chris@kbenefits.com

 

 

GetCoveredNJ
Healthcare.gov

Chris Kudryk
#7990501

 

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