Medicare Advantage and Plan G both have their advantages, which makes some people wonder if they can have both. These two kinds of Medicare plans are completely different. Medicare Advantage plans offer an alternative to Original Medicare, whereas Plan G is a Medigap plan that provides supplemental coverage to Medicare.
Since their both so different, can you have Medicare Advantage and Plan G? The short answer is no, you can’t have both. However, it’s important to understand why this can’t be done to protect yourself against all the Medicare misinformation you can find on the web.
Medicare Advantage (Part C) plans are sold through private insurance companies. They’re considered an alternative or replacement for Original Medicare. Chances are you’ve heard about these plans on TV commercials.
When you enroll in Medicare Advantage, you’ll get all your Medicare benefits from the private insurance carrier rather than the federal government. The exception is hospice benefits, which you’ll still get from Medicare Part A. Cost-sharing is different than with Original Medicare, and those charges will vary from plan to plan.
Medicare Advantage plans also have provider networks, unlike Original Medicare. You need to seek care within the network to avoid higher fees. That may be a drawback to Medicare Advantage plans, but there are also several benefits.
Part C plans often have low monthly premiums and extra benefits you won’t get from Original Medicare. Some plans even include prescription drug coverage, which means you won’t need to purchase a separate Part D plan.
Plan G is one of the Medigap plans available from private insurance companies. Medigap plans are so-called because they fill in the “gaps” in Original Medicare. They act as a secondary insurance plan, with Parts A and B being your primary insurance. Your Medigap plan will pick up some or all of the remaining deductibles, copays, and coinsurance amounts.
There are about ten Medigap plans available to beneficiaries. Plan G happens to be one of the most popular options. It picks up every remaining expense except the Part B deductible. Medicare Advantage plans have their “advantages,” to be sure. But many people see the appeal of having a Plan G, which offers more predictable coverage.
Outside of the coverage, Medigap plans also have fewer limitations and treatment restrictions. There are no provider networks, so you can see any healthcare provider that accepts Medicare.
The downside is that Plan G has a higher monthly premium and none of the extra benefits that you find in Medicare Advantage plans. You’ll need to enroll in a separate Part D plan, as well as dental, vision, and hearing insurance, if you would like coverage for those areas.
Medicare Advantage plans will not coordinate benefits with Plan G. Remember, if you have Plan G, Original Medicare is your primary payor. But, if you have Medicare Advantage, none of your benefits run through Original Medicare. The two kinds of Medicare plans cannot work in tandem. You must choose one or the other. As they say, you can't have your cake and eat it, too!
You are allowed to try both options at different times to find out which one works best for you. If you decide to do this, you should be aware of some rules and timelines. Outside of your Initial Enrollment Period, you must be healthy enough to pass medical underwriting to get a Medigap plan. That means that if you don’t enroll in Plan G as soon as you are eligible, you may not ever be able to get a Medigap policy.
However, you can try Medicare Advantage for 12 months. If you decide Medicare Advantage isn’t for you within those 12 months, you can change back to Original Medicare and a Medigap plan with no questions asked.
This can sometimes be a tricky process, so work with an advisor at Local Medicare Specialists to make sure the transition goes smoothly.
It’s not always easy to decide between Medicare Advantage and Plan G. You’ll have to learn more about how each one works, weigh the pros and cons, and consider your healthcare needs and budget.
Our Medicare advisors will help you through this entire process. We provide education on all Medicare products and can help you wade through the decisions. We want you to have the knowledge you need so that you can feel confident in your decision. Call today and speak with a local Medicare advisor near you.
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LocalMedicareSpecialists.com is privately owned and operated by LMS Insurance LLC. LocalMedicareSpecialists.com is a non-government resource for those who depend on Medicare, providing Medicare information in a simple and straightforward way.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area which are United Healthcare, Aetna, Humana, Cigna, Blue Cross Blue Shield of Arizona, Centene, Devoted, and Scan. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.