Do Medigap Plans Have Network Restrictions?

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What Do You Know About That Medigap Plan You’re Interested In?

Let’s say you’ve looked into Medicare Advantage plans. You’ve seen some that come fairly close to meeting your needs, but they don’t quite hit the mark. Instead, you’re considering purchasing a Medigap supplement insurance plan to “fill in the gaps” left by your Original Medicare coverage.

You’ve found a Medigap plan that bears a price that you can afford. You feel that it provides extra coverage that you couldn’t get through a Medicare Advantage plan. It feels perfect, aside from one last major concern…

Does this Medigap plan have network restrictions? Will you be able to get the coverage you need from any provider, in or out of your network?

For the most part, the answer is “no”. Medigap plans do not usually have network restrictions. Only in one rare case will you find a Medicare supplement plan that has network coverage restrictions. More on that later, though.

So, how do you know if certain supplemental plans for Medicare have network restrictions? Let’s dive in and take a deeper look.

Medigap Insurance: A Quick Primer

Much like Medicare Advantage plans, Medigap supplemental insurance plans are sold by private insurance providers. If you have Original Medicare (Medicare Part A and Part B), Medigap plans will fill in most of the “gaps” left by Original Medicare coverage.

In order to buy a Medigap policy, you must currently have Original Medicare. While the upside is that Medicare supplement plans cover what your Original Medicare plan may not, the downside is that you’ll pay two, three, or sometimes four, monthly premiums. You’ll not only have to pay your Medigap monthly premium, you’ll also have to pay your Medicare Part B premium.

To add on, if your Medicare Part A plan isn’t zero-cost, you’ll be responsible for that premium. Those of you who have Part D Prescription Drug plans will be responsible for those premiums as well.

Medigap vs. Medicare Advantage

Before we go any further, it must be noted that you cannot have a Medicare supplement plan and Medicare Advantage at the same time. It is illegal for a provider to sell you both at the same time. You will only be able to purchase Medigap plans if you can prove that you are switching from Medicare Advantage to Original Medicare.

Now, with that out of the way…

You may have heard that Medigap plans and Medicare Advantage plans are essentially the same. While they may share some similarities, Medigap plans and Medicare Advantage plans are actually quite different. What are some of the differences in choosing Medigap vs. Medicare Advantage?

Let’s take a look, starting with Medicare Advantage:

Medicare Advantage:

• Offers the same coverage as Original Medicare, plus sometimes includes extra coverage for dental, vision, and hearing services
• Can only enroll or switch in a Medicare Advantage plan during specific yearly time periods
• May be required to use healthcare providers in your specific network
• Specialist visits often require referrals
• Can be packaged with Medicare Part D Prescription Drug coverage
• Can enroll no matter your health condition

Supplemental Plans for Medicare (Medigap):

• Typically only “fills in the gaps” left by Original Medicare, covering certain costs that Original Medicare plans do not (coinsurance, copayments, etc.)
• Medigap plans can be purchased any time after you’ve turned 65 and enrolled in Medicare Part B
• Accepted nationwide by any doctor that accepts Medicare, with rare exceptions
• Specialist visits do not require referrals
• Medicare Prescription Drug coverage is not included
• Can purchase no matter your health condition

As you can see, when you look at Medigap vs. Medicare Advantage, the differences become very clear. While Medigap is considered insurance, it doesn’t offer the coverage that Medicare Advantage can. However, you may not need the coverage offered by Medicare Advantage, so Medigap plans may be just the ticket for you!

Should I Be Worried About Medigap Plan Network Restrictions?

So, do Medigap plans have network restrictions? Technically, some do, but it’s very rare to stumble across a Medigap plan with network restrictions.

There’s only one Medigap plan that has network restrictions, and that plan is called Medicare SELECT. These plans have low premiums, but to pay less, they restrict you to a specific provider in your network. However, if you’re out of network and you experience an emergency, you’ll be able to use your Medicare SELECT plan to help pay for care in that instance.

Medicare Select plans are harder to find than other supplemental plans for Medicare. Even if they are available in your area, you may choose to forego these Medicare supplement plans in favor of other options that allow for coverage in any network.

How Do I Decide Between Medigap vs. Medicare Advantage?

Both Medigap and Medicare Advantage plans are great options. They help cover costs that Original Medicare plans do not, and they offer peace of mind as far as how much you’ll need to pay Out-of-Pocket for medical services and treatments. Choosing one over the other heavily depends on your own personal needs.

If you’re still mulling your choice, our friendly licensed insurance agents can help you narrow things down. Give us a call today to discuss the options that are available near you. Not ready to call? That’s okay – just enter your zip code into our free plan finder tool to begin researching and comparing Medigap and Medicare Advantage plans in your area.