Original Medicare + Medigap vs Medicare Advantage

How Coverage Works

Original Medicare vs Medigap

Medicare pays 80% of infusion service costs.

Medigap (supplemental plan) can cover most or all of the 20% balance..

No prior authorization usually required.

You can use any provider that accepts Medicare.

Out-of-pocket costs are often minimal.

Medicare Advantage (Part C)

Private plans that replace Original Medicare.

Must use in-network providers.

Plans may require biosimilars instead of reference biologics.

Annual out-of-pocket maximum applies, but costs for infusions can still be high.

Some patients cannot be infused at our center because of high out-of-pocket costs or biosimilar restrictions.

Original Medicare + Medigap

Example
– Medicare pays 80% ($8,000 of a $10,000 bill).
– Medigap covers most/all of the $2,000 balance.
– Estimated patient cost: $0–$200.

Medicare Advantage

Example
– Patient pays plan copay/coinsurance (e.g., 20% = $2,000).
– Prior authorization required; biosimilars may be mandated.
– Estimated patient cost: $500–$2,000+ depending on plan.

How We Help

Verify & Estimate

We check network, prior authorization, and give cost estimates.

Biosimilar Review

We confirm if your plan requires a biosimilar and if we can provide it.

Support & Alternatives

We help with copay cards/foundation support and coordinate alternative care sites if needed.

Key Takeaway

Original Medicare + Medigap: Usually the lowest cost and simplest path.
Medicare Advantage: More complex, often higher costs, and sometimes limits where or how you can be infused.

Educational purposes only.
Coverage depends on plan; confirm with Medicare or your insurance provider.

Are You Ready

Schedule Your Appointment Today.

Our infusion nurses have 10+ years of experience, and an on-site provider ensures safety throughout treatment.

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