KBenefits
Insurance - Medicare - Retirement

Medicare Supplements vs Medicare Health Plans

What's The Difference?:

 Medigap vs MAPD?

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

Network:

  • Medigap:  All hospitals and ~95% of providers in America accept medigap plans.
  • MAPD:  Networks vary carrier to carrier, plan to  plan.  Doctor and provider networks can be limited to just NJ access.

Plan Benefits:

  • Medigap:  Plan benefits are standardized by the govt.  Plan benefits are the same carrier to carrier.
  • MAPD:   Plan benefits vary carrier to carrier, plan to plan. Plan benefits can change upon yearly renewal.

Prescription:

  • Medigap:  No prescription coverage.  You must buy a standalone Part D prescription plan.  You can change your Part D prescription plan yearly upton Annual Open Enrollment, Oct 15t to Dec 7th.
  • MAPD:   Prescription card is built into the health plan.  You can’ not change the prescription card that comes with the health plan.

Premium:

  • Medigap:  (Higher) There is a higher premium for the coverage and network access.
  • MAPD:       (Lower) Lower premium. Some carriers offer zero premium plans.

Max-out-of-Pocket Expenses:

  • Medigap:  (Lower) Your out of pocket costs would be your Part B deductible and Part D prescriptions out of pocket costs at the pharmacy.
  • MAPD:      (Higher) Can be as high as $7,100 for In-Network services in addition to prescription costs at the pharmacy.

Flexibility:

  • Medigap:  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 a Medigap policy, medical questions are asked and the carrier can deny your request to enroll.
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Christopher S. Kudryk
Call:  732-333-1976
Fax:   732-444-5971
chris@kbenefits.com

 

 

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Chris Kudryk
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