Medicare decisions can feel overwhelming, especially when you’re trying to maximize your coverage and minimize costs. One of the most common questions Medicare beneficiaries ask is whether they can have both a medicare advantage plan and a supplemental plan to get the best of both worlds.
The short answer is no – federal law prohibits having both types of coverage simultaneously. This restriction exists for important legal and practical reasons that protect consumers and maintain the integrity of the Medicare system.
In this comprehensive guide, we’ll explain exactly why you cannot have both plans together, explore your coverage options, and help you make the right choice for your healthcare needs and budget.
Key Takeaways
You cannot have both a medicare advantage plan and a medicare supplement (Medigap) plan simultaneously
It is illegal for insurance companies to sell medigap coverage to someone enrolled in medicare advantage
Medicare Advantage bundles hospital coverage, medical, and often prescription drug coverage into one plan meant to cover about the same as original Medicare with no supplement
Medigap works only with Original Medicare Parts A and B to cover out of pocket costs such as the deductibles, copays and coinsurance.
You must choose between medicare advantage or original medicare plus medigap – not both
You can improve on your Medicare Advantage health insurance coverage by adding a hospital indemnity plan and a cancer protection plan at a low cost.
Special enrollment periods allow switching between these options under certain circumstances
Medicare Advantage and Medicare Supplement Plans
Before diving into why you cannot have both types of coverage, it’s essential to understand how each plan type functions within the broader Medicare system.
What is Medicare Advantage?
Medicare Advantage plans, also known as Medicare part C, serve as an alternative to Original Medicare coverage. These plans are offered by private insurers (non-government) approved by Medicare and are expected to provide at least the same level of benefits as original medicare Parts A and B.
A Medicare Advantage plan typically includes:
Comprehensive coverage including hospital insurance (Part A) and medical insurance (Part B)
Often includes prescription drug coverage (Part D) and additional benefits like dental, vision care, and hearing services that can change or be removed annually.
Provided by for profit insurance companies approved by Medicare
May include wellness programs and other supplemental services
Usually has network restrictions and may require referrals for specialists
Most plans operate as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). HMO plans generally restrict you to their plan’s network of providers and may require referrals for specialist care, while PPOs offer more flexibility but usually come with higher costs for out-of-network services.
Medicare Advantage plans are paid on a capitated basis by the federal government – a set amount per enrollee per month – to deliver Medicare-covered benefits. As of 2024, over 50% of all Medicare beneficiaries are enrolled in Medicare advantage plans, representing a historic high in the program’s popularity. Unfortunately, Medicare Advantage plans cost the taxpayer 20% more than Original Medicare according to the latest MedPac statistics.
Medigap Seminars Insurance Agency Reviews.
What is Medicare Supplement Insurance?
Medicare supplement insurance plans, commonly called Medigap, works hand-in-glove with Original Medicare Parts A and B to help pay for gaps in coverage. These standardized insurance policies are designed specifically to cover some or all of the out of pocket costs left by Original Medicare.
A Medicare supplement insurance plan covers:
Helps pay for deductibles, coinsurance, and copayments from original Medicare
Does not cover prescription drugs (requires separate Part D plan for medications)
Provides standardized benefits that are the same across insurance companies
Allows you to see any doctor in the U.S. or U.S. territory who accepts Medicare
Does not require referrals to see a specialist or get a second opinion.
Medicare supplement insurance plan benefits are standardized and labeled A through N. Each lettered plan must provide the same benefits regardless of which insurance company sells it, though premiums may vary by company and location. Not all plan types are available in all states, and plans F and C are no longer available to new Medicare beneficiaries as of 2020.
One of the primary advantages of medigap coverage is provider access. medigap enrollees can visit any healthcare provider nationwide that accepts medicare, without network restrictions or referral requirements.
Why You Cannot Have Both Plans Together
Federal law explicitly prohibits having medicare advantage and medigap simultaneously. This prohibition exists for several important reasons that protect both consumers and the integrity of the Medicare system.
Legal Prohibitions
The Centers for Medicare & Medicaid Services (CMS) make it illegal for insurance companies to sell medigap policies to individuals already enrolled in a medicare advantage plan. If a medigap policy application indicates current medicare advantage coverage, the insurer must decline the sale unless there is written proof of the applicant’s switch back to original medicare.
This protection is enforced under federal regulation to prevent wasteful, duplicative coverage and maintain the integrity of the public-private Medicare partnership.
Fundamental Differences in Function
The two plan types serve completely different roles within the Medicare system:
medicare advantage plans replace original medicare entirely for most medical services, while medigap supplements original medicare coverage
advantage plans typically include prescription drug coverage and additional benefits such as dental and vision in a bundled, managed-care format
medigap plans cover only the out of pocket expenses for covered services under original medicare, but not prescription drugs or routine dental/vision care
Having both would create redundant coverage that serves no practical purpose. medicare advantage plans already include the hospital coverage and medical services that medigap is designed to supplement.
How to Improve Your Medicare Advantage Benefits
Although you cannot add a Medicare supplement insurance plan to an Advantage plan, there are other health insurance policies that fit very well with an Advantage plan to improve your coverage similar to that of a Medicare supplement insurance plan.
Cancer Protection Insurance Plan
The first would be a cancer protection plan. All Medicare Advantage plans only cover 80% of your cancer care up to your maximum out of pocket limit. It should be noted that the maximum out of pocket limit allowed by Medicare can increase every year and may be substantially higher 15 years from now than it is today. By adding a cancer protection plan your incurance will pay you a tax-free lump sum check when first diagnosed with cancer. YOu can then use those funds as you wish to pay your medical bills or other needs during cancer treatment. Any leftover funds once you have completed treatment are your to keep.
Hospital Indemnity Plan
The second health insurance plan would be a hospital indemnity plan. Your Medicare Advantage plan will likley have a large deductible you need to pay whenver you are admitted into a hospital as an inpatient. A hospital indemnity plan will pay you a set amount determined when you create the policy that can be used to pay that deductible so you have no out of pocket hospital costs, just like with a Medicare supplement insurance plan.
Enrollment Periods and Switching Options
Understanding when you can enroll in each type of plan is crucial for making informed decisions about your medicare coverage.
Medicare Advantage Enrollment Periods
medicare advantage plans have several enrollment opportunities throughout the year:
Initial Enrollment Period (IEP)
Starts 3 months before, includes the month of, and extends 3 months after turning 65
Available when you first become eligible for Medicare
No medical underwriting required
Annual Open Enrollment Period (AEP)
October 15 to December 7 each year
Anyone with medicare can change from original medicare to medicare advantage, medicare advantage to original medicare, or switch between medicare advantage plans
Changes take effect January 1
Medicare Advantage Open Enrollment Period (MA OEP)
January 1 to March 31 annually
Those already in an advantage plan can switch to another medicare advantage plan or disenroll and return to original medicare
Limited to one change per period
Special Enrollment Periods (SEPs)
Triggered by qualifying life events such as moving out of your plan’s service area
Loss of employer coverage or plan termination
Available for 63 days after the qualifying event
Medigap Enrollment Periods
medigap enrollment is more restrictive and timing-sensitive:
6-month Open Enrollment Period
Starts when you turn 65 and enroll in medicare part b
Guaranteed issue rights during this period – insurers cannot deny coverage, limit benefits, or charge higher premiums due to pre-existing conditions
Most important enrollment window for medigap coverage
Guaranteed Issue Rights
Available in certain circumstances such as losing medicare advantage coverage
If your medicare advantage plan is ending or you move out of your plan’s service area
During the “trial period” for new medicare advantage enrollees
Medical Underwriting Outside Protected Periods
Outside of guaranteed issue periods, insurers may use medical underwriting
This can result in denied coverage, benefit limitations, or higher premiums
Some states provide additional protections for those under 65 with disability
How to Switch Between Plan Types
Switching between medicare advantage and original medicare plus medigap requires careful planning and attention to timing.
Switching from Medicare Advantage to Medigap
The process involves several critical steps:
Disenroll from medicare advantage during an appropriate enrollment period
Return to original medicare coverage (Parts A and B)
Enroll in a medicare supplement plan within 63 days of losing medicare advantage coverage
Purchase a separate medicare drug plan (part d) for prescription drug coverage
Maintain documentation proving end of medicare advantage coverage
Important Considerations:
You may be subject to medical underwriting if you don’t have guaranteed issue rights
Missing the 63-day enrollment window can result in permanent loss of medigap access
You’ll need separate drug coverage since medigap policies don’t include prescription drugs
Switching from Medigap to Medicare Advantage
This process is generally simpler:
Enroll in a medicare advantage plan during the annual enrollment period
Your medigap policy becomes unnecessary for medicare advantage-covered services
Consider keeping or canceling your medigap policy based on state rules and your plans
Most people cancel their medicare supplement insurance plan when switching to medicare advantage since the coverage becomes redundant.
Comparing Medicare Advantage vs. Original Medicare Plus Medigap
Understanding the key differences between these options will help you make the best choice for your situation.
| Feature | Medicare Advantage | Original Medicare + Medigap |
|---|---|---|
|
Provider Network |
Usually restricted to plan’s network |
Any provider that accepts medicare |
|
Referrals |
Often required for specialists |
No referrals needed |
|
Prescription Drug Coverage |
Usually included |
Requires separate part d plan |
|
Additional Benefits |
Often includes dental, vision, hearing |
Generally not covered |
|
Out-of-pocket costs |
Annual maximum ($8,850 in 2024) |
Varies by medigap plan type |
|
Premiums |
Often lower or $0 |
Higher monthly premiums |
|
Travel coverage |
Limited to service area |
Nationwide coverage |
|
Foreign emergency care
|
Varies by plan |
Some medigap plans include limited coverage |
Cost Comparison
Medicare advantage plans typically feature:
Lower or even $0 additional premiums beyond Medicare part b
Higher potential copayments, coinsurance, and deductibles
Annual out-of-pocket maximums that cap your total costs
Potential savings for those with minimal healthcare needs
Original Medicare plus medigap typically involves:
Higher monthly premiums in addition to Medicare part b premium
Very low or zero additional out of pocket expenses for covered services
Separate part d premium for prescription drugs
More predictable costs for frequent healthcare users
Provider Access and Networks
medicare advantage plans usually require you to use providers within the plan’s network. While emergency care is always covered, routine care is typically limited to the plan’s service area. Some plans offer limited out-of-network benefits at higher costs.
medigap provides the broadest possible access – you can see any healthcare provider nationwide that accepts Medicare, with no network restrictions or referral requirements.
Additional Benefits
medicare advantage plans often include benefits not covered by original medicare, such as:
Routine dental, vision, and hearing services
Wellness programs and gym memberships
Over-the-counter medication allowances
Transportation services
Telehealth options
medigap policies focus solely on covering the gaps in original Medicare and generally don’t offer these additional benefits.
Making the Right Choice for Your Needs
Choosing between Medicare advantage and original Medicare plus medigap depends on several personal factors.
Healthcare Needs Assessment
Consider your current and anticipated healthcare needs:
Choose Medicare Advantage if you:
Don’t mind network restrictions and referral requirements
Want additional benefits like dental and vision coverage
Prefer predictable copayments over percentage-based coinsurance
Live in an area with good medicare advantage plan options
Choose Original Medicare plus Medigap if you:
Have chronic conditions requiring frequent specialist care
Travel frequently or spend time in multiple states
Want the freedom to see any doctor that accepts medicare
Prefer predictable healthcare costs
Value continuity of care with specific providers
Geographic Factors
Your location significantly impacts your options:
Rural areas may have limited medicare advantage plan choices
Urban areas typically offer more plan competition and benefits
State-specific medigap regulations vary
Provider networks differ substantially by region
Conclusion
While you cannot have a medicare advantage plan and a supplemental plan simultaneously, understanding your options helps you make the best choice for your healthcare needs and budget. The decision between medicare advantage and original medicare plus medigap involves weighing factors like provider access, costs, additional benefits, and your personal healthcare situation.
Remember that Medicare decisions have long-term consequences, and switching between plan types becomes more difficult over time due to medical underwriting requirements. Take advantage of your initial enrollment periods and guaranteed issue rights to secure the coverage that best fits your needs.
If you’re unsure which option is right for you, consider consulting with a licensed insurance agent or contacting your State Health Insurance Assistance Program (SHIP) for personalized guidance based on your specific circumstances.
FAQ
No, federal law prohibits having both medicare advantage and medigap coverage simultaneously. insurance companies cannot legally sell medigap policies to medicare advantage enrollees except during specific switching periods with proper documentation.
If you attempt to enroll in both, the insurance company must refuse to sell you medigap coverage if you’re enrolled in medicare advantage. Any existing medigap policy may be cancelled once you enroll in medicare advantage.
You can only switch during specific enrollment periods. The best opportunities are during the annual enrollment period (october 15 – December 7) or the medicare advantage open enrollment period (January 1 – March 31). However, you may face medical underwriting for medigap unless you have guaranteed issue rights.
It depends on your situation. You have guaranteed issue rights if your medicare advantage plan is discontinued, you move out of the service area, or you’re in your trial period. Otherwise, you may be subject to medical underwriting.
Yes, medigap policies don’t include prescription drug coverage (except for policies sold before 2006). You’ll need to purchase a separate medicare drug plan to avoid late enrollment penalties.
Yes, you can switch back to medicare advantage during the annual enrollment period. However, once you leave medigap, you may not be able to get it back without medical underwriting, depending on your state’s rules.
The trial period allows new Medicare beneficiaries who choose medicare advantage when first eligible to try the plan for up to 12 months. If they’re not satisfied, they can return to original medicare and purchase medigap without medical underwriting.
You typically have 63 days after your medicare advantage coverage ends to enroll in medigap under guaranteed issue rights. Missing this window may result in medical underwriting or denied coverage.
