What’s the key difference in how Medicare Advantage and Medigap handle out-of-network providers?

Answered by 4 licensed agents

Medicare Advantage often ties you to a network—go out-of-network, and you’re either paying more or not covered at all, unless it’s an emergency, which I’ve seen trip up clients who didn’t check their plan’s rules. Medigap, paired with Original Medicare, doesn’t care about networks; any provider accepting Medicare works, giving you flexibility I’ve found folks appreciate when they travel or need specialists. It’s a clear-cut distinction that hits home when you’re picking between the two.

Answered by Brian Moore on March 26, 2025

Broker Licensed in OH

Answered by Brian Moore Medicare Insurance Agent

Their are no networks with original Medicare, whereas Advantage plans have in-network and out of network providers. Under an Advantage plan, if the provider agrees to treat you, there is usually a bigger maximum out of pocket (moop). So if the provider accepts the Advantage plan, there should be no difference in medical services, just in how it's paid. With a Medigap, th eout of pockets are very limited, and with an Advantage plan the out of pocket can be significant like $8000 or thereabouts.

Answered by William Kravit on March 25, 2025

Agent Licensed in WI, AZ, CO & 9 other states

Answered by William Kravit Medicare Insurance Agent

Medicare Advantage plans typically require that you stay and get your healthcare within a network of providers, and it has a potentially higher cost for out-of-network care. Meanwhile, with Medigap, you can see any doctor or hospital that accepts Medicare.

Answered by Comfort Olude on March 30, 2025

Broker Licensed in CA, FL, GA & 9 other states

Answered by Comfort Olude Medicare Insurance Agent

There is no network of doctors with Medigap plans. As long as the facility and or doctor accept original Medicare then the Medigap pays after Medicare. Medicare advantage are managed care plans and have a network of providers to help manage cost and then may offer to provide some additional benefits

Answered by James Schneider on March 31, 2025

Broker Licensed in OH, FL & MI

Answered by James Schneider Medicare Insurance Agent

Tags: Medicare Advantage

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What’s the key difference in how Medicare Advantage and Medigap handle out-of-network providers?

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What’s the key difference in how Medicare Advantage and Medigap handle out-of-network providers?

Agents: Share Your Expertise

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website