Medicare Advantage (Part C) is a popular choice, but it’s not for everyone. Some people find its network restrictions, unpredictable costs, or coverage limitations frustrating.
If you’re looking for an alternative, options like Original Medicare, Medigap (Medicare Supplement), private health insurance, and Medicaid may offer better flexibility and coverage for your needs
📞 Need help choosing a Medicare plan? Call (920) 545-4884 for a free consultation!
Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). Many people switch back from Medicare Advantage because of its nationwide coverage and freedom to choose providers.
Why Choose Original Medicare?
✅ No Network Restrictions – See any doctor or hospital that accepts Medicare
✅ Predictable Coverage – Standardized benefits, no sudden plan changes
✅ Pairs with Medigap for Lower Out-of-Pocket Costs
However, Original Medicare does not cover:
❌ Prescription drugs (requires a separate Part D plan)
❌ Routine vision, dental, or hearing care
❌ Long-term care services
🔗 Related Article: Can I Go Back to Original Medicare?
Comparing Medicare Advantage vs. Original Medicare
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Doctor Choice | ✅ Any provider accepting Medicare | ❌ Must use in-network doctors |
| Referral Needed? | ✅ No | ❌ Yes, often for specialists |
| Hospital Coverage | ✅ Yes, under Part A | 🔹 Yes, but network restrictions apply |
| Out-of-Pocket Costs | ❌ Higher unless combined with Medigap | ✅ Copays, deductibles, out-of-pocket max |
| Prescription Drug Coverage | ❌ No (requires Part D) | ✅ Often included |
| Extra Benefits | ❌ No | ✅ Often includes dental, vision, hearing |
If you stay with Original Medicare, you may want Medigap to help cover out-of-pocket costs like:
- Deductibles (e.g., Part A hospital deductible of $1,632 in 2025)
- Coinsurance (Medicare pays 80%, you cover 20%)
- Copayments (Costs for doctor visits and hospital stays)
Types of Medigap Plans
There are 10 standardized Medigap plans labeled A through N. The most popular are:
| Medigap Plan | Covers Part A Deductible? | Covers Part B Coinsurance? | Foreign Travel Coverage? |
|---|---|---|---|
| Plan F | ✅ Yes | ✅ Yes | ✅ Yes |
| Plan G | ✅ Yes | ✅ Yes | ✅ Yes |
| Plan N | ✅ Yes | ❌ Yes (with copay) | ✅ Yes |
Get your free Medicare supplement quote today!
Get My Quote🔗 Related Article: Is Medicare Advantage Better Than Medigap?
If you’re not satisfied with Medicare, private health insurance may be an option. This includes:
1. Employer-Sponsored Retiree Plans
Some employers offer retiree health plans that work alongside Medicare to provide:
✅ Lower costs for hospital and doctor visits
✅ Prescription drug coverage included
✅ Additional benefits like dental and vision
2. Short-Term Health Plans
These are temporary insurance plans for seniors who:
✔ Are delaying Medicare enrollment
✔ Need gap coverage before their Medicare plan starts
🔗 Related Article: Why Is Medicare Advantage So Controversial?
If you have a low income, you may qualify for Medicaid, which can work alongside Medicare.
If you have a low income, you may qualify for Medicaid, which can work alongside Medicare to lower costs. Medicaid covers:
✔ Medicare Part A & B Premiums
✔ Copays & Coinsurance
✔ Prescription Drugs (Extra Help)
✔ Long-Term Care (Nursing Homes & Home Health Services)
However, not all Medicaid beneficiaries get full benefits. The level of assistance you receive depends on which Medicaid program you qualify for.
Levels of Medicaid Assistance for Medicare Beneficiaries
If you qualify for Medicare Savings Programs (MSPs), Medicaid will help with different costs:
🔗 Related Article: How Does Medicare Advantage Work with the VA?
| Medicaid Level | Who Qualifies? | What’s Covered? |
|---|---|---|
| Qualified Medicare Beneficiary (QMB) | ✅ Lowest income seniors | ✅ Pays **Medicare Part A & B premiums, deductibles, and copays** |
| Specified Low-Income Medicare Beneficiary (SLMB) | 🟡 Slightly higher income than QMB | ✅ Pays **Medicare Part B premium only** |
| Qualifying Individual (QI) | 🟡 Limited spots available each year | ✅ Pays **Medicare Part B premium** (first come, first served basis) |
| Qualified Disabled & Working Individual (QDWI) | ❌ Disabled workers under 65 who lost SSDI benefits | ✅ Pays **Medicare Part A premium only** |
1. What is the best alternative to Medicare Advantage?
The best alternative depends on your health needs and budget:
- Original Medicare + Medigap – Best for freedom of choice and predictable costs
- Employer-Sponsored Retiree Plans – Ideal for extra benefits like dental and vision
- Medicaid – Best for low-income seniors needing cost assistance
📞 Need help picking the right plan? Call (920) 545-4884 for a free Medicare consultation!
2. Can I switch from Medicare Advantage to Original Medicare?
Yes, but only during specific enrollment periods:
| When You Can Switch | Enrollment Period |
|---|---|
| Annual Enrollment Period | Oct 15 – Dec 7 |
| Medicare Advantage Open Enrollment | Jan 1 – Mar 31 |
| Special Enrollment Period | Depends on qualifying life events |
🔹 If switching to Original Medicare, you can also enroll in Medigap (but may require underwriting).
📞 Want help switching? Call (920) 545-4884 today!
3. How do I enroll in Medigap after leaving Medicare Advantage?
If you’re switching from Medicare Advantage to Original Medicare, you may qualify for a Medigap Guaranteed Issue Right, meaning:
✅ No medical underwriting required
✅ No premium increases due to pre-existing conditions
✅ Must enroll within 63 days of leaving Medicare Advantage
🔗 Related Article: Is Medicare Advantage Better Than Medigap?
📞 Need help applying for Medigap? Call (920) 545-4884 today!
4. Does Original Medicare cover everything?
No, Original Medicare (Parts A & B) does not cover:
❌ Prescription Drugs (requires Part D)
❌ Dental, Vision, or Hearing Services
❌ Long-Term Care (Nursing Homes or Assisted Living)
Many people add Medigap or Medicaid for extra coverage.
5. What is the biggest downside of Medicare Advantage?
The biggest drawbacks of Medicare Advantage include:
- Limited Provider Networks – You must use in-network doctors
- Higher Out-of-Pocket Costs – Copays, deductibles, and out-of-pocket max apply
- Plan Changes Annually – Costs, benefits, and networks can change every year
🔗 Related Article: Why Is Medicare Advantage So Controversial?
6. Is Medigap more expensive than Medicare Advantage?
Yes, Medigap typically has higher monthly premiums, but it reduces out-of-pocket costs in the long run.
| Feature | Medigap + Original Medicare | Medicare Advantage |
|---|---|---|
| Premiums | Higher monthly cost | Low or $0 premiums |
| Doctor Choice | Any provider accepting Medicare | In-network only |
| Out-of-Pocket Costs | Minimal with Medigap | Copays & annual max apply |
🔹 If you want fewer surprise costs, Medigap is often the better choice.
📞 Need a cost comparison? Call (920) 545-4884 for a free quote!
7. Can I get Medigap if I have Medicaid?
No, Medicaid already covers many out-of-pocket costs, so Medigap is not necessary if you qualify for Medicaid.
✔ Medicaid pays Medicare premiums & deductibles
✔ Covers long-term care services that Medigap does not
✔ Includes extra benefits like dental & vision
8. Do Medicare Advantage plans change every year?
Yes! Medicare Advantage plans update yearly, and changes may include:
🔹 Premiums & Deductibles – Costs may increase
🔹 Network Changes – Your doctor may no longer be covered
🔹 Drug Formulary Updates – Medications covered can change
9. What happens if I miss the Medicare Open Enrollment deadline?
If you miss Medicare’s Annual Enrollment Period (Oct 15 – Dec 7), your options depend on your situation:
| Scenario | Possible Solution |
|---|---|
| You missed the deadline | You may qualify for Medicare Advantage Open Enrollment (Jan 1 – Mar 31) |
| You have a special situation | Special Enrollment Period (moving, losing employer coverage, etc.) |
| You need drug coverage | Medicare Part D Late Enrollment Penalty applies if you go without coverage |
📞 Missed your deadline? Call (920) 545-4884 to see if you qualify for a Special Enrollment Period!
10. Can I have employer insurance and Medicare at the same time?
Yes, you can keep employer coverage while on Medicare. However, which plan pays first depends on the size of your employer:
✔ If your employer has 20+ employees – Employer insurance pays first
✔ If your employer has fewer than 20 employees – Medicare pays first
🔹 Many people enroll in Medicare Part A (hospital coverage) while keeping employer insurance.
| Scenario | Possible Solution |
|---|---|
| You missed the deadline | 🔹 You may qualify for **Medicare Advantage Open Enrollment (Jan 1 – Mar 31)** |
| You have a special situation | ✅ You may be eligible for a **Special Enrollment Period (SEP)** if you moved, lost employer coverage, or experienced a qualifying life event. |
| You need drug coverage | 🟡 If you enroll late, a **Medicare Part D late enrollment penalty** may apply. |
| No qualifying reason | ❌ You must wait until the **next Annual Enrollment Period** (Oct 15 – Dec 7) to make changes. |
Final Thoughts & Next Steps
Medicare Advantage isn’t for everyone. The best alternatives include:✔ Original Medicare + Medigap – Best for predictable costs & no networks
✔ Employer Retiree Plans – Good for added benefits
✔ Medicaid – Best for low-income seniors needing extra coverage
📞 Need expert guidance? Call (920) 545-4884 for a free Medicare consultation!
🔗 Related Article: Are Medicare Advantage Commercials Misleading?
