Medicare C or Medigap: What are the differences?
You can’t purchase both Medicare Part C and Medigap. You’ll need to choose the option that best fits your needs. Here’s how they compare.
Medicare C (aka Medicare Advantage)
- Lower premiums
- Higher out-of-pocket costs that vary by plan; each plan has an out-of-pocket maximum
- HMO or PPO option: possible limited in-network doctor selection or out-of-network rules
- Referral to see specialist often required
- Usually only local or regional coverage
- Usually includes Medicare Part D as part of the premium
- Some include extra coverage for vision, dental and hearing aids
- Rule of thumb: Those who seldom see the doctor often opt for the lower premiums of Medicare Part C.
If you sign up for Medicare Part C, review your coverage annually. Coverage, benefits and costs of Medicare Part C plans change each year. Reviewing your plan could save you money, help you find a better coverage fit — or both.
Medigap (aka Medicare Supplement Insurance)
- Higher premiums (can be up to 2 or 3 times that of Medicare C)
- Usually $0 on out-of-pocket costs
- Accepted everywhere that accepts Medicare
- Usually referrals are not required to see a specialist
- Generally accepted in every state or U.S. territory and some plans may be accepted internationally when traveling
- Medicare Part D must be purchased separately
- Coverage for extras must be added through additional plans
- Rule of thumb: Those who need frequent medical care often choose Medigap to keep their total medical costs flat.
It may not be advantageous to switch plans when enrolled in Medigap. During the initial enrollment period for Medigap, you’ll receive guaranteed issue:
- One standard rate regardless of your health status
- No denial of coverage based on your health status
In most instances, if you later switch, you’ll no longer receive this protection, meaning that changing Medigap plans could cost you money.