Medigap vs. Medicare Advantage
Medigap vs. Medicare Advantage: Which Path is Right for You?
One of the quickest ways to start making sense of Medicare is to understand the two very different paths available once you sign up for Original Medicare:
Medigap and Medicare Advantage.
If you're new to Medicare, it’s easy to feel like you’re drowning in options. There are Parts A, B, C, and D… Plan letters like G and N… TV commercials promising cash back or gift cards… but barely any of them actually explain what these plans really are.
Why Medigap and Medicare Advantage Are Complete Opposites
Let’s start with the basics.
Once you’ve signed up for Original Medicare (that’s Parts A and B), you’ll likely want extra coverage because Medicare doesn’t cover everything.
You have two choices for that additional coverage:
- Medigap (also known as a Medicare Supplement plan)
- Medicare Advantage (Part C)
These are polar opposites. You can’t have both. You pick one or the other.
Medigap: Keeping Original Medicare as Your Foundation
Medigap plans are sold by private insurance companies, but your primary insurance remains Original Medicare.
This means:
- Medicare pays first.
- Your Medigap plan kicks in to cover leftover costs (like the hospital deductible and Part B 20%).
- You can go to any doctor nationwide who accepts Medicare.
- There are no networks and no referrals needed.
Think of it as a “plug-in” plan that helps cover your out-of-pocket costs for you.
- Great for those who want flexibility and predictability.
Medicare Advantage: A Private Replacement for Medicare
With a Medicare Advantage plan, you’re getting your Medicare benefits through a private insurance company, not the federal government.
This means:
- Medicare pays the private plan a flat monthly rate to take over your coverage.
- You follow the rules and networks of that private plan.
- Benefits can change from year to year.
- You may need referrals or prior authorizations for certain services.
It’s more like traditional health insurance you may have had through work.
- Great for those looking for lower monthly premiums and bundled coverage (like dental, vision, and prescription drugs).
A Quick Comparison
Here’s how to think about it:
| Medigap | Medicare Advantage |
|---|---|
| Keeps Original Medicare in place | Replaces Original Medicare |
| Higher monthly premium | Low or $0 premium |
| Predictable costs | Variable out-of-pocket costs |
| Nationwide access to Medicare providers | Limited networks (HMO/PPO) |
| No prior authorizations needed | May require approvals for services |
| Drug plan purchased separately (Part D) | Drug coverage often included |
Cost and Risk: What to Know
Medigap plans offer more predictability.
You pay your monthly premium and a small deductible, and that’s often it. For example, with Plan G, your max out-of-pocket could be under $2,000 a year.
Medicare Advantage plans often come with more financial risk. You may have a $0 premium, but you could face out-of-pocket costs up to $9,350/year (or less, depending on the plan). Copays, coinsurance, and surprise bills are more common.
What No One Tells You
Here’s a big one:
If you
start on an Advantage plan, you might not be able to
switch to a Medigap plan later, especially if you develop health issues. That’s because Medigap plans often require you to answer
health questions unless you're in a special enrollment window (like turning 65 or leaving employer coverage).
You may only get one “free shot” to get a Medigap plan without health questions. That’s a huge deal and not something most people find out until it’s too late.
What About Drug Coverage?
- Medigap: You’ll need to buy a separate Part D drug plan.
- Medicare Advantage: Most plans include drug coverage at no extra cost.
Can You Switch Between the Two?
Yes, but there are rules.
- From Medigap to Advantage: Easy. You can do this during fall Open Enrollment (Oct 15–Dec 7).
- From Advantage to Medigap: Harder. You need to apply for a Medigap plan and pass health underwriting in most states, unless you're within a guaranteed issue period.
There is a 12-month trial right if you joined an Advantage plan when you first enrolled in Medicare, but it only applies in specific situations.
So… Which One’s Better?
There’s no one-size-fits-all answer. It depends on:
- Your budget
- Your preferred doctors
- Your travel needs
- Your risk tolerance
- And whether you value flexibility or simplicity
Some folks want to keep premiums low and are comfortable with higher out-of-pocket risk. Others want stability, freedom to choose doctors, and fewer surprises.
Want Help Making the Right Choice?
I offer 100% free help—no strings attached.
Whether you’re starting from scratch, stuck between plan options, or just want to run your decision by someone who gets it, I’m here for you. I’ll guide you through the process step by step and support you for the life of your plan.
You don’t have to do this alone.
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