What is the best insurance to go with Medicare for seniors?

Over 65 million Americans rely on Medicare for their health coverage, but Original Medicare doesn't cover everything. Choosing what is the best insurance to go with Medicare for seniors requires understanding your options to find the perfect fit for your health and budget.

Quick Summary

The best insurance to pair with Medicare for seniors depends on individual health and financial situations, involving a choice between a Medicare Supplement (Medigap) plan, which fills gaps in Original Medicare, or a Medicare Advantage (Part C) plan, which offers an all-in-one alternative with network limitations.

Key Points

• Medigap vs. Advantage: Your two main paths are Medigap (supplements Original Medicare) or Medicare Advantage (replaces Original Medicare).

• Freedom vs. Network: Medigap offers freedom to see any Medicare-accepting doctor; Medicare Advantage often requires staying within a specific network (HMO/PPO).

• Cost Structure: Medigap typically has higher monthly premiums but fewer out-of-pocket costs. Medicare Advantage has lower premiums but requires copays and has an annual out-of-pocket maximum.

• Prescription Drugs: Medigap requires a separate Part D plan. Most Medicare Advantage plans include prescription drug coverage.

• Extra Benefits: Many Medicare Advantage plans include dental, vision, and hearing benefits that Medigap does not cover.

• Enrollment Time: Initial Medigap enrollment is the best time to join without medical underwriting. Medicare Advantage enrollment is more flexible, with annual enrollment periods.

• Finding the Best Plan: The optimal choice depends on your personal health needs, budget, and lifestyle, not a universal ranking.

Understanding Your Main Medicare Options

Choosing the right insurance to complement Original Medicare is a crucial decision that impacts your healthcare and finances for years to come. There is no single "best" plan, as the ideal choice depends entirely on your specific health needs, budget, and lifestyle. The two primary paths for supplemental coverage are Medicare Supplement Insurance (Medigap) or a Medicare Advantage (Part C) plan. They are fundamentally different approaches and you cannot have both at the same time.

The Medigap Route: Filling the Gaps in Original Medicare

If you choose to stay with Original Medicare (Parts A and B), a Medigap policy is the most comprehensive way to cover the associated out-of-pocket costs. These standardized policies, labeled with letters like Plan G or Plan N, are sold by private insurance companies. Their benefits are federally standardized, meaning a Plan G from one insurer offers the exact same coverage as a Plan G from another. The only variation is the premium.

Here’s how Medigap works:

• Original Medicare pays its share first.
• Your Medigap policy then pays for its share of Medicare-approved costs, such as copayments and deductibles.
• This predictability can make budgeting for healthcare expenses much easier.

A major benefit of Medigap is that it offers freedom to see any doctor or specialist in the U.S. who accepts Medicare, without network restrictions. It also typically provides coverage for foreign travel emergencies. However, Medigap policies do not include prescription drug coverage, so you must enroll in a separate Medicare Part D plan.

Common Medigap Plans for New Enrollees (post-2020):

• Plan G: Now the most comprehensive option available to new Medicare beneficiaries. It covers all gaps in Original Medicare, except for the Part B deductible.
• Plan N: This plan typically has a lower premium than Plan G but requires small copayments for some office and emergency room visits.

The Medicare Advantage Path: An All-in-One Alternative

Instead of supplementing Original Medicare, a Medicare Advantage (MA) plan replaces it. These are all-in-one plans offered by private companies that contract with Medicare. When you enroll in an MA plan, you get your Part A and Part B coverage from the private company, not the government. Many MA plans also include prescription drug coverage (MAPD), meaning you don't need a separate Part D plan.

Key features of Medicare Advantage plans:

• Extra Benefits: Most plans offer additional benefits not covered by Original Medicare, such as dental, vision, and hearing care.
• Cost Structure: These plans often have lower or even $0 monthly premiums. However, you'll have to pay copayments, coinsurance, and deductibles as you use services. All MA plans have an annual out-of-pocket maximum to protect you from catastrophic costs.
• Network Restrictions: The main trade-off is network limitations. You will likely be enrolled in a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO). With an HMO, you must see doctors within the plan's network, while a PPO offers more flexibility at a higher cost.

A Side-by-Side Comparison

To help decide what is the best insurance to go with Medicare for seniors, consider this comparison:

Feature	Medicare Supplement (Medigap)	Medicare Advantage (Part C)
Coverage Type	Supplements Original Medicare; fills gaps like deductibles and coinsurance.	Replaces Original Medicare; provides all Part A and Part B services.
Network	Freedom to see any doctor or hospital nationwide that accepts Medicare.	Typically requires using a plan's specific network of doctors and hospitals (HMO, PPO).
Cost	Higher monthly premiums; fewer out-of-pocket costs when you use services.	Lower or $0 monthly premiums; out-of-pocket costs like copays apply but capped by an annual maximum.
Prescription Drugs	Must purchase a separate Part D plan.	Most plans include Part D coverage (MAPD).
Extra Benefits	Does not offer dental, vision, or hearing benefits.	Many plans include dental, vision, and hearing coverage.
Enrollment	Can be difficult to get after your initial 6-month Medigap Open Enrollment period if you have pre-existing conditions.	Can switch plans annually during the Annual Enrollment Period.

How to Choose the Right Insurance for You

Making an informed decision requires a personal assessment of several factors.

Your Health and Healthcare Needs

• Do you have chronic health conditions? If so, predicting your healthcare expenses can be difficult. The predictable, low out-of-pocket costs of a Medigap plan might be reassuring.
• Do you prefer a specific doctor or specialist? If you have a trusted relationship with your current healthcare providers, check if they are in the network of any Medicare Advantage plans you consider. If not, Medigap offers the flexibility to keep them.

Your Budget and Financial Priorities

• Monthly Premiums vs. Out-of-Pocket Costs: Are you willing to pay a higher monthly premium for a Medigap plan to have minimal out-of-pocket costs when you receive care? Or would you prefer a lower premium with an MA plan, accepting that you will pay copays and coinsurance throughout the year, capped by a maximum out-of-pocket limit?
• Extra Benefits: Evaluate the value of dental, vision, and hearing benefits that come with many MA plans. Would you pay for these services out-of-pocket anyway? If so, an MA plan might offer better overall value.

Your Lifestyle and Location

• Travel: For seniors who travel frequently, especially outside the U.S., a Medigap policy offers robust coverage that most MA plans do not. This can provide peace of mind while away from home.
• Service Area: Your location is critical, as MA plan availability and network coverage vary greatly by county. Medigap policies, while standardized, also have different premium costs based on where you live.

Conclusion: Making Your Final Choice

Ultimately, what is the best insurance to go with Medicare for seniors is a personal decision that requires careful research. Medigap provides the most freedom and predictable costs, while Medicare Advantage offers a more integrated, often lower-premium plan with extra benefits but network restrictions.

Weigh your priorities: predictable costs and doctor freedom (Medigap) or lower premiums and extra benefits (Medicare Advantage)? Don't rush into a decision; compare options, consider your long-term health, and consult a trusted advisor or the official resources to find the plan that best suits your needs. To start your research, visit the official Medicare website at https://www.medicare.gov for detailed information on plans available in your area.

Frequently Asked Questions

Can I have both a Medigap policy and a Medicare Advantage plan?

No, you cannot. A Medigap policy only works with Original Medicare. If you enroll in a Medicare Advantage plan, you are getting your Medicare benefits from that private plan instead of Original Medicare, so your Medigap policy would not cover any costs.

If I choose a Medigap policy, do I need a separate Part D plan for prescriptions?

Yes, if you choose Original Medicare and a Medigap policy for supplemental coverage, you must enroll in a separate Medicare Part D prescription drug plan to cover the cost of your medications.

How do I choose between a Medicare Advantage HMO and a PPO plan?

The choice depends on your need for flexibility. An HMO requires you to use doctors and hospitals within the plan's network and often needs referrals to see specialists. A PPO allows you to see out-of-network providers for a higher cost and typically doesn't require referrals.

What is the best insurance to go with Medicare for seniors who travel a lot?

For seniors who travel frequently, especially outside the U.S., a Medigap policy is often the better choice. Medigap plans offer more comprehensive emergency travel coverage than most Medicare Advantage plans.

What if I have pre-existing conditions? Is Medigap still an option?

Yes, but timing is critical. Your Medigap Open Enrollment Period is the best time to enroll because insurers cannot deny you coverage or charge higher premiums based on your health. Outside this period, you may face medical underwriting and could be denied or charged more.

Are there any Medicare Advantage plans with $0 premiums?

Yes, many Medicare Advantage plans have $0 premiums, though they still require you to pay your standard Medicare Part B premium. These plans make their money through the copayments and coinsurance you pay when you receive care.

Where can I find the best insurance to go with Medicare for seniors in my specific area?

The best way to find plans available in your area is to use the plan finder tool on the official Medicare website (medicare.gov). You can also contact your State Health Insurance Assistance Program (SHIP) for free, local counseling.