Covering the Gaps: What Happens After Original Medicare?
After you enroll in Medicare Parts A and B and receive your Medicare card, your next step is deciding how to cover the remaining out-of-pocket costs that Original Medicare does not fully pay. These “Gaps” include specialist care, prescription medications, and other essential services.
After getting Parts A & B, most choose between 2 paths:
Medicare Advantage (Part C)
Medicare Advantage (Part C / MAPD) plans replace Original Medicare as your primary coverage.
Most Medicare Advantage Plans bundle hospital, medical, and prescription drug coverage into one comprehensive plan.
MAPD plans are a great option for healthy individuals who want affordable monthly premiums. However, MAPD coverage often will not cover as much when compared to a Medigap plan with a standalone Part D plan.
For example, a 30-day supply of generic medication might cost $30 on your MAPD plan; For that same medication, it may be closer to $2-3 with the right Part D coverage.
This is due to various restrictions, such as a lack of cost-sharing for higher-tier medications and/or limited provider networks.
Medicare Supplement + Part D
Medicare Supplement (‘Medigap’ or ‘Med supp’) plans work alongside Original Medicare, but these plans require a separate standalone drug plan (Part D or PDP) for your medications.
Medigap plans – like ‘Plan N‘ or ‘Plan G‘ – will help cover the gaps; the out-of-pocket after visiting the doctor.
Plans are generally standardized across America, which means Plan N from one carrier = Plan N from another
(pricemay be different, but coverage is not).
Medigap plans are accepted by any doctor in the United States that accepts Medicare. Medigap (WITH a Part D plan) is best for individuals who visit the doctor frequently, travel often, or regularly take high-cost prescription medications.