These costs can include costs like Medicare Part A coinsurance, the Medicare Part A deductible or Part B coinsurance. Medigap plans do not typically offer additional benefits beyond what Original Medicare covers.
Medicare Advantage is used as an alternative to Original Medicare. A Medicare Advantage plan will replace your Original Medicare coverage.
You’ll receive the same benefits that are offered by Medicare Part A and Part B, but from a private insurance company.
Many Medicare Advantage plans offer additional coverage for services and items not found in Original Medicare.
You cannot have a Medicare Advantage plan and a Medicare Supplement Insurance plan at the same time.
Medicare Supplement Insurance
3,998 different plans were available nationwide in 20231
10 standardized plans available in most states, though all 10 may not be available to you in every state
Available to beneficiaries enrolled in Original Medicare who live in the plan’s service area
More widely available to people over age 65 in some states, though younger people can be eligible to apply for a plan depending on where they live
Initial Enrollment Period, Medicare Annual Election Period and Special Enrollment Periods. No medical underwriting required
Enrollment is year-round, but enrolling during your Medigap Open Enrollment Period or during a period when you qualify for a guaranteed issue right can be beneficial
Medical underwriting may be utilized if not applying for a policy during your Medigap Open Enrollment period or when you have a guaranteed issue right
Over 30 million Medicare beneficiaries1
Over 15 million Medicare beneficiaries2
Coverage of Medicare out-of-pocket costs
No coverage of Original Medicare out-of-pocket costs, but MA plan out-of-pocket costs may be more affordable than what Original Medicare includes
Coverage for Medicare Part A and B deductibles, copayments and coinsurance (depending on the plan)
Additional health benefits not found in Original Medicare
Can offer additional benefits not found in Original Medicare
No additional benefits to what Medicare offers, except for qualified emergency care received outside of the U.S.
Why should I enroll in a Medicare Supplement Insurance plan?
When you use Medicare Part A or Part B benefits, you’ll often be left with some out-of-pocket expenses like deductibles, coinsurance or copayments. This is known as “cost sharing.”
That’s where Medicare Supplement Insurance comes into play. As the name implies, this type of plan is used alongside your Original Medicare coverage.
Here are a few examples of how a Medigap plan can work:
You schedule a doctor’s appointment with a doctor for services that are covered by Medicare Part B. The doctor accepts Medicare “assignment” — this means she accepts Medicare’s reimbursement rate for all covered services as payment in full.
Medicare Part B does not cover doctor’s appointments in full. After you meet your Part B deductible ($240 per year in 2024), you’ll typically be responsible for the 20 percent of the Medicare-approved amount billed for the services you receive.
If you had a Medigap plan that fully covers this 20 percent Part B coinsurance (and you already met your Part B deductible), you would pay nothing out-of-pocket for the appointment.
You are admitted to the hospital for Medicare-approved inpatient care. Before Medicare Part A provides any coverage, you’ll have to first meet the Part A deductible of $1,632 in 2024.
The Part A deductible must be met for each benefit period. A benefit period starts once you’re admitted for inpatient care, and it ends when you haven’t receiving inpatient hospital care for 60 days. You could potentially need to meet this deductible more than once in a given year.
If you had a Medigap plan that fully covers this Part A deductible, you would pay nothing out-of-pocket toward your deductible.
You visit a doctor who does not accept Medicare’s rate as full payment for their services. This means they can charge you up to 15 percent more than the Medicare-approved amount for their services. These costs are known as Medicare Part B excess charges.
If you had one of the two Medigap plans (Plan F or Plan G) that cover Part B excess charges, you wouldn’t have to pay for these additional costs.
What do Medicare Supplement Insurance plans cover?
* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020,... you may still be able to enroll in Plan F or Plan C as long as they are available in your area.
1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,800 in 2024. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.
2 Plan K has an out-of-pocket yearly limit of $7,060 in 2024. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3 Plan L has an out-of-pocket yearly limit of $3,530 in 2024. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.+ Read more
Each type of plan offers partial or full coverage for a different combination of these benefits.
Medicare Part A coinsurance While it’s not common to require a hospital stay long enough to incur Medicare Part A coinsurance charges, these costs can range up to $816 per day in 2024 for extended stays at hospitals and other inpatient facilities.
Medicare Part B coinsurance Medicare Part B typically requires a 20 percent coinsurance payment for Medicare-approved services and items after you meet your Medicare Part B deductible.
Medicare Part A deductible The Medicare Part A deductible is $1,632 per benefit period in 2024. The Medicare Part A deductible is not annual — you could potentially need to meet this deductible more than once in a given year.
Medicare Part B deductible The Medicare Part B deductible is $240 per year in 2024.
Medicare Part B excess charges Doctors who do not accept Medicare assignment reserve the right to charge up to 15 percent more than the Medicare-approved amount for services and items they provide. These costs are called excess charges.
Medicare Part A coinsurance and copayments for hospice care Medicare Part A generally requires you to pay a copayment for prescription drugs used for hospice treatment. You are typically also responsible for hospice respite care coinsurance costs.
Medicare Part A coinsurance for skilled nursing facility care Medicare Part A requires a coinsurance payment of $204 per day in 2024 for inpatient skilled nursing facility stays longer than 20 days.
First three pints of blood Original Medicare does not provide coverage for the first three pints of blood used for a blood transfusion.
Foreign travel emergency care In most cases, Original Medicare does not provide coverage for emergency medical care received outside of the U.S. Several Medigap plans cover 80 percent of emergency medical care received abroad.
What is Medicare Advantage?
Medicare Advantage plans are a type of private Medicare insurance that offers all of the same benefits as Original Medicare.
Medicare Advantage plans also offer benefits that are not covered by Original Medicare.
Benefits, plan availability, and costs can vary from plan to plan. Be sure to check with your plan’s Explanation of Coverage to find out exactly what is covered.
A licensed insurance agent can help you compare Medicare Advantage plans in your area, including the benefits they offer.
What are the advantages and disadvantages of Medicare Advantage plans?
Some potential benefits of having a Medicare Advantage plan include:
All Medicare Advantage plans have an annual out-of-pocket spending max, which Original Medicare does not offer.
Some Medicare Advantage plans offer low premiums.
Many Medicare Advantage plans offer benefits which are not covered by Original Medicare.
Some potential downsides of a Medicare Advantage plan can include:
Certain types of Medicare Advantage plans (such as Medicare HMO plans or Medicare PPO plans) may limit you to a provider network. If so, you’ll be required to visit health care providers who are in the plan network for your care to be covered.
The provider networks in some Medicare Advantage plans may be small — limited to a certain geographic region. This could be an issue if you travel frequently or live in different parts of the country during certain times of the year.
Whether or not a Medicare Advantage plan is a good fit for you will depend on your personal health care and budget needs.
There were 3,998 Medicare Advantage plans available around the U.S. in 2023.1
How do I choose between Medicare Supplement Insurance and a Medicare Advantage plan?
Over 30 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. This accounts for over half the total Medicare-eligible population.1
Roughly 15 million Medicare beneficiaries are enrolled in a Medicare Supplement Insurance plan.2
With the two types of insurance being very popular among Medicare beneficiaries, how do you choose which type of coverage is right for you?
Here are a few factors you can consider when deciding.
The average monthly premium for a 2024 Medicare Advantage plan is $13.24.3
You’ll also still pay your Medicare Part B premium in addition to your Medicare Advantage plan premium.
The average monthly premium for the popular Medicare Supplement plan G in 2023 was $135.4
Some people may choose to enroll in a Medicare Supplement Insurance plan so they can save money on their out-of-pocket Medicare costs. Medicare Supplement Insurance is accepted by any health care provider who also accepts Medicare.
Some people may choose to enroll in a Medicare Advantage plan because the premiums are typically lower than Medigap plan premiums, or because they are drawn to the additional benefits many Medicare Advantage plans offer.
In the end, it all depends on the type of health care you need and the manner in which you expect to use your insurance.
It may help to have a conversation with a licensed insurance agent who can review your medical needs and help you decide which type of plan might be most beneficial for your situation.
Your Health Care Needs
Deciding between these two types of plans can also boil down to what your needs are.
Do you take prescription drugs?
Do you want coverage for benefits Original Medicare doesn't cover?
If so, you might consider the benefits of enrolling in a Medicare Advantage plan.
Do you have a health condition that requires frequent trips to the doctor or the use of medical equipment in your home?
Do you expect to undergo surgery or other major procedures in your future?
Do you frequently travel outside of the U.S.?
If so, certain types of Medicare Supplement plans might be a good choice for you.
Learn about Medigap plans in your area
A licensed insurance agent can help learn about the Medigap plans that are sold in your area.
Learn about Medicare Supplement plans available where you live.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
3 TZ Insurance Solutions analysis of data provided by the Centers for Medicare & Medicaid Services (CMS), including the 2024 MA Landscape Source Files as well as carrier-provided plan data provided by Sun Fire Inc.
4 Internal sales data provided by TZ Insurance Solutions LLC, 2023. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.
Choosing a Medicare Advantage plan doesn’t have to be a roll of the dice. This simple five-step guide can help you find the best Medicare Advantage plan for your health care needs and your budget. Read more
Plan F and Plan G are the most comprehensive Medicare Supplement plans. Discover the key differences between Medicare Supplement Insurance Plan F and the Medigap plan that may soon become the most popular Medigap plan, Medigap Plan G. Read more