Virginia Medicare Advantage vs. Medigap
Medicare Advantage vs. Medigap in Virginia: Two Ways to Fill the Gaps in Original Medicare
Medicare Advantage and Medigap (Medicare Supplement) solve the same problem in different ways. A plain-English comparison of how each works, the trade-offs, and who each tends to fit in Virginia.
The biggest Medicare decision most people make
Original Medicare doesn't pay everything. You still owe deductibles and coinsurance, and there is no yearly limit on what you could owe. Medicare Advantage and Medigap are the two main ways people deal with that, and they work very differently.
Here is an honest comparison for people in Virginia, including the trade-offs on both sides.
Medicare Advantage vs. Medigap in Virginia
We help people across Virginia, including Virginia Beach, Richmond and Norfolk. Medicare's enrollment rules are federal and the same in every state, but the plans sold, and what they cost, depend on where you live, and a licensed agent can talk through what is available to you in Virginia today.
Free, unbiased Medicare counseling is also available in Virginia through VICAP (Virginia Insurance Counseling and Assistance Program), at 1-800-552-3402. That is a separate resource from GetFastRates.com, and it is worth a call whether or not you ever talk to us.
Questions or complaints about an insurance company or agent in Virginia can go to Virginia State Corporation Commission, Bureau of Insurance (www.scc.virginia.gov).
How Medicare Advantage works
- A private insurance company runs your Medicare benefits through a plan, in place of Original Medicare
- You keep Part A and Part B, and you still pay your Part B premium
- Most plans include prescription drug coverage, and many add benefits such as dental, vision or hearing
- Plans have a yearly limit on what you pay out of pocket for covered in-network care
- Most plans use a network (HMO or PPO), and some services need approval in advance, called prior authorization
- Some plans have no monthly plan premium, though you still pay your Part B premium and copays
How Medigap (Medicare Supplement) works
In most states the lettered Medigap plans (Plan A, Plan G and so on) have the same benefits from one company to the next, so the main differences between companies are price and service. A few states standardize Medigap differently, so we'll confirm what is sold where you live.
- You keep Original Medicare, and a Medigap policy from a private company pays part of the costs Medicare leaves, such as deductibles and coinsurance, depending on the plan
- You can generally see any doctor or hospital in the country that accepts Medicare, with no network and generally no referrals
- You pay a monthly premium for the Medigap policy, on top of your Part B premium
- Medigap does not include prescription drug coverage, so most people add a separate Part D plan
- Medigap generally does not cover dental, vision or hearing care
- Medigap policies are generally renewable each year, which means the company can't cancel you as long as you pay your premium
The honest trade-offs
Premiums, deductibles and copays change from year to year and depend on the plan, where you live and, for some costs, your income. We won't quote a figure before we know your details, and we'll put the costs in front of you in writing before you decide.
- Medicare Advantage can cost less each month and add benefits, but you may have network rules, prior authorization and copays each time you use care
- Medigap premiums are usually higher each month, but your costs when you use care are usually more predictable and you can use any provider that accepts Medicare
- Medicare Advantage plans can change their benefits, costs and networks every year, so a plan that fits this year may not next year
- Medigap premiums can go up over time, and the way a company sets them (by your age when you buy, by your current age, or the same for everyone) affects how
- Switching later is not always simple. Outside certain windows, a Medigap company may ask health questions and can decline you or charge more
Timing matters for Medigap
You have a Medigap open enrollment period for six months starting the month you are 65 or older and enrolled in Part B. During it, a company can't turn you down or charge you more because of your health. After it ends, in most cases a company can ask health questions. Some people have additional rights, such as when a Medicare Advantage plan ends or in your first year of trying a Medicare Advantage plan, and some states add protections.
Who each one tends to fit
- People who want the widest choice of doctors and hospitals nationwide and steadier costs often look at Medigap
- People who want a lower monthly cost, drug coverage in one plan and extra benefits, and who are comfortable with a network, often look at Medicare Advantage
- People who travel or live in more than one place often weigh network rules more heavily
- Neither is right for everyone. The right answer depends on your doctors, your prescriptions, your health and your budget
How we can help
- Check whether your doctors and prescriptions fit the plans you are looking at
- Show the costs of each option side by side, in writing
- Explain your enrollment timing so you don't lose a right you have
- Tell you honestly if one option isn't a good fit for you
Before you rely on this page
This page is educational. It is not a recommendation of any plan, and it does not promise eligibility, enrollment, pricing or availability.
GetFastRates.com is not connected with or endorsed by the U.S. government or the federal Medicare program. Calling connects you with licensed insurance help. Plan availability, costs, benefits, and enrollment rules can vary by state, carrier, and individual situation.
We do not offer every plan available in your area. We represent a limited number of organizations, which offer a limited number of products in your area. Please contact Medicare.gov, 1-800-MEDICARE (1-800-633-4227), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
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Common questions
What is the difference between Medicare Advantage and Medigap?
Medicare Advantage replaces Original Medicare with a private plan that has its own rules, network and costs. Medigap works alongside Original Medicare and pays part of what Medicare leaves, with no network. They aren't designed to be used together.
Can I have Medigap and Medicare Advantage at the same time?
No. Medigap is meant to work with Original Medicare, and it is generally against the rules for a company to sell you Medigap if you are in a Medicare Advantage plan.
Does Medigap cover prescriptions?
No. If you have Medigap, you generally need a separate Part D plan for drug coverage.
Can I switch from Medicare Advantage to Medigap later?
You can usually go back to Original Medicare during certain enrollment periods, but getting a Medigap policy afterward may involve health questions, and you could be declined or charged more. There are exceptions, such as a one-time trial period when you first join Medicare Advantage and when your plan ends, so check your timing before you switch.
Are both options available in Virginia?
Medicare Advantage and Medigap are available across the country, but the specific plans and companies depend on where you live, and Medicare Advantage plans are set by county. A licensed agent can tell you what is available in Virginia today.
Does it cost anything to talk to an agent?
Talking through your options with us is free and comes with no obligation. Any plan you choose has its own premium, set by the plan and its insurance company.
You don't have to figure this out alone.
Call to talk with a licensed agent who helps people in Virginia who will be honest about what fits and what doesn't.
- Licensed insurance help
- No guaranteed eligibility, pricing, or availability
- Educational starting point
GetFastRates.com is not connected with or endorsed by the U.S. government or the federal Medicare program. Calling connects you with licensed insurance help. Plan availability, costs, benefits, and enrollment rules can vary by state, carrier, and individual situation.