Medigap vs. Medicare Advantage

Two Different Approaches to Medicare Coverage

When you join Medicare, you have a fundamental choice: Original Medicare with Medigap, or Medicare Advantage. These are very different types of coverage, and you can only have one or the other (not both).

What Is Medicare Advantage?

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare, offered by private insurance companies. These plans must cover everything Original Medicare covers, and often include extras like dental, vision, and prescription drugs.

Key Differences

Provider Networks

• Medigap: See any doctor who accepts Medicare, anywhere in the U.S. No network restrictions
• Medicare Advantage: Limited to plan's network (HMO, PPO, etc.). May need referrals to see specialists

Costs

• Medigap: Monthly premium plus Medicare Part B premium. Predictable costs
• Medicare Advantage: May have low or $0 premium, but copays for each service. Out-of-pocket maximum applies

Coverage

• Medigap: Supplements Original Medicare. Often includes prescription drug coverage separately
• Medicare Advantage: Replaces Original Medicare. May include drug coverage, dental, vision, hearing

Switching

• Medigap: Keep for life. Can switch plans but may need medical underwriting
• Medicare Advantage: Can switch during annual enrollment. Switching back to Medigap may be difficult

Which Is Right for You?

Choose Medigap if you:

• Want freedom to see any Medicare doctor
• Travel frequently or spend time in different locations
• Prefer predictable healthcare costs
• Don't want network restrictions
• See specialists regularly

Choose Medicare Advantage if you:

• Want extra benefits like dental and vision
• Prefer lower monthly premiums
• Are comfortable with network restrictions
• Don't mind seeking prior authorization for services
• Live in one area year-round