Medigap vs. Medicaid and Medicare Advantage

It is illegal to sell a Medigap policy to someone in a Medicare Advantage plan (unless their enrollment is ending) or on Medicaid (unless Medicaid pays the Medigap premium, or pays only the Part B premium) — a person qualifying for both Medicaid and Medicare rarely needs a supplement because the coverages overlap. Medicare Advantage (Part C) combines Original Medicare services with supplement-style extras: the private insurer handles Part A and B claims (Medicare pays it to do so); plans may add dental, eyeglasses, or wellness benefits; types include HMO, PPO, PFFS, SNP, HMO-POS, and MSA plans; plans must cover all Original Medicare services EXCEPT hospice care, must cover emergencies outside the service area (but not outside the U.S.), usually include Part D drug coverage, and may or may not charge a monthly premium. Medicaid itself is the joint state/federal program for people with limited income — states administer within federal guidelines with federal subsidy.

Advantage and Medigap are an either/or; Medicaid plus Medigap is a no — with narrow premium-payment exceptions.