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Medigap (Medicare Supplement Insurance) and Medicare Advantage are two different ways to supplement or enhance Medicare coverage, but they work quite differently. Here's a comparison to clarify the differences:

Medigap (Medicare Supplement)

Medigap is designed to fill the gaps in Original Medicare (Part A and Part B), covering things like copayments, coinsurance, and deductibles. It's a supplement to Original Medicare and is used to reduce out-of-pocket costs.

Medigap only works with Original Medicare. They keep their Medicare Parts A and B, and Medigap helps cover the gaps in that coverage. It doesn't cover additional services like dental, vision, or prescription drugs.

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Cost differences and How to Enroll

Networks and Access to Providers

Medigap Vs Medicare Advantage

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• With Medigap, they are able tp use any doctor or hospital that accepts Medicare nationwide. There's no need for referrals or to worry about being "in-network."
• Medicare Advantage plans often have network restrictions (such as HMOs or PPOs). They may need to use a network of doctors and hospitals, and may need referrals to see specialists. If they go out of network, their costs may be higher.

Medicare Advantage

Medicare Advantage(Part C) is an alternative to Original Medicare. It's offered by private insurance companies and replaces Original Medicare with a plan that often includes additional benefits like vision, dental, and drug coverage (Part D).

Medicare Advantage plans must cover all the services that Original Medicare does, but they often include additional benefits like prescription drugs (Part D), dental, vision, and wellness programs. However, plans can vary in what they offer.

Click here to learn about enrollment

In summation Medigap works alongside Original Medicare to cover out-of-pocket costs, with no networks and fewer additional benefits. Whereas Medicare Advantage replaces Original Medicare with a plan that often includes extra benefits but comes with networks and out-of-pocket costs when services are used.

The terms secondary insurance and supplemental insurance are often used interchangeably, but they have different meanings in health insurance. Here's a breakdown of the differences:

Supplemental Insurance

Supplemental insurance provides additional coverage that is not included in the primary health insurance. It can help cover specific healthcare costs that aren’t typically paid for by traditional insurance, such as out-of-pocket expenses or extra benefits like hospital stays, accidents, or critical illness.

Supplemental insurance plans pay fixed benefits in specific situations. For instance, a supplemental plan might pay you a lump sum if they're diagnosed with cancer, have an accident, or require hospitalization, regardless of what the primary insurance pays.

Secondary Insurance: Its primary role is to coordinate benefits and reduce out-of-pocket costs after the primary insurance has processed a claim. Supplemental Insurance: Its purpose is to fill gaps in coverage or provide additional financial protection for specific situations not covered by your main insurance.

Purpose:

Supplemental Vs secondary Insurance

Click here to see an example of Supplemental Insurance!

Secondary Insurance

Secondary insurance is a health insurance policy that pays after primary insurance has paid its share. It covers costs that the primary insurance didn't fully pay for, such as copayments, coinsurance, and deductibles. The secondary insurer only pays after the primary insurance has processed the claim.

If they have more than one health insurance plan, the second plan (secondary) can help cover the costs left over after the primary plan pays. For example, if the primary insurance covers 80% of a hospital bill, the secondary insurance might pay the remaining 20%.

Click here to see an example of Secondary Insurance!

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Unexpected accidents happen every day, and people can get hurt. If they have accident coverage and a covered accident happens to you, this coverage can help protect their finances by paying a lump-sum benefit payment. They can use the benefit payment for anything from out-of-pocket medical expenses, to extra help around the house, transportation, or anything else they may need.

For Secondary Insurance, if they have two employer health plans (theirs and a spouse's), one plan acts as primary insurance, and the other as secondary. After the primary plan covers its portion, the secondary insurance might cover the remainder.

Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.

The Donut hole

Begins on January 1st, the beginning of your coverage year. During this stage you are responsible for paying your prescription drug costs, up until you reach your plan deductible, which is $545 for 2024.Begins when you’ve reached your deductible. At this point you are responsible only for co-pays each time you fill a prescription.begins when you and your plan (combined) have spent $5030 (2024) on prescription drugs for the year (including the deductible) You’re now in the Donut Hole, and you will pay a percentage toward each of your medications.Once you spend up to a threshold of $8000 for the year (2024), you move into this stage. Part D now covers 95 percent of the cost of your prescriptions, and you are responsible for just 5 percent.

Are the donuts getting stale? 2025 might be donut free!

How does the donut hole work?

The donut hole can seem overwhelming, but it’s just one of four payment stages with Medicare Part D. The payment stage you’re in determines the amount you pay when you fill a prescription. You always begin each year in the deductible stage or the initial coverage stage, depending on your plan. A final helpful tip is to learn about each of the Part D payment stages and understand how your financial responsibilities will change in each.It is important to remember nebulized medications are not affected by the donut hole as DirectRx bills through Medicare part B (medical coverage).

What is a donut hole?

TRICARE is the uniformed services health care program for active duty service members (ADSMs), active duty family members (ADFMs), National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.

TRICARE offers special programs for certain health conditions, populations, or concerns.

Please watch this short video that includes a few testimonials from TRICARE recipients!

Tricare

TRICARE has two coverage regions:

TRICARE brings together the health care resources of the Military Health System—such as military hospitals and clinics—with a network of civilian health care professionals, institutions, pharmacies, and suppliers to foster, protect, sustain, and restore health for those entrusted to their care.

Click here to see some of the special programs offered.

Health Vs Pharmacy Insurance?

Insurance Deep Dive: a deeper look into the options

Supplemental Vs Secondary Insurnace?

Medigap Vs Medicare Advantage?

Donut hole?

TRICARE?

Let's take a closer look at the options above so we can better understand our patients and what other choices they may have!

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Medigap has a monthly premium for the policy, in addition to the Medicare Part B premium. The out-of-pocket costs are generally lower because Medigap helps cover deductibles, copays, and coinsurance.With Medicare Advantage: the policy holder typically pays their Part B premium, and some Medicare Advantage plans have additional premiums. However, many plans have low or even $0 premiums, but they'll face copayments, coinsurance, and deductibles when they use services.

To enroll in Medigap they must have Original Medicare (Parts A and B) to purchase a Medigap policy. The best time to buy is during the Medigap Open Enrollment Period, which starts when someone turns 65 and enrolls in Part B. During this period, they're guaranteed to get coverage regardless of health issues.For Medicare Advantage, they can enroll in a plan during the Initial Enrollment Period, the Annual Enrollment Period (October 15 to December 7), or if they qualify for a Special Enrollment Period.