Choosing between Medicare Advantage and Medigap can be difficult. Each option has benefits and drawbacks depending on your healthcare needs, budget, and doctor preferences. This guide provides a detailed comparison to help you decide.
| Section | Jump To |
|---|---|
| What is Medicare Advantage? | Go to Section |
| What is Medigap? | Go to Section |
| Key Differences | Go to Section |
| Pros and Cons of Each Plan | Go to Section |
| Which Plan is Right for You? | Go to Section |
| FAQs | Go to Section |
What is Medicare Advantage?
Medicare Advantage (Part C) is a private insurance alternative to Original Medicare. These plans often include:
✔ Lower monthly premiums
✔ Extra benefits (dental, vision, hearing, and prescription drugs)
✔ Network-based coverage (HMO or PPO plans)
Most Medicare Advantage plans require you to use network providers. HMO plans require referrals for specialists, while PPO plans allow out-of-network care at a higher cost.
What is Medigap?
Medigap (Medicare Supplement Insurance) is designed to cover out-of-pocket costs that Original Medicare does not pay, such as:
✔ Copayments, coinsurance, and deductibles
✔ Freedom to see any doctor nationwide who accepts Medicare
✔ More predictable healthcare costs
Medigap does not cover prescription drugs, dental, vision, or hearing, so enrollees must purchase a separate Medicare Part D plan for medications.
Key Differences Between Medicare Advantage and Medigap
| Feature | Medicare Advantage | Medigap |
|---|---|---|
| Monthly Cost | Lower premiums | Higher premiums |
| Out-of-Pocket Costs | Higher (copays, coinsurance) | Lower (covers deductibles, copays) |
| Provider Network | Limited (HMO/PPO networks) | Any Medicare-accepting doctor |
| Prescription Drug Coverage | Included in most plans | Requires a separate Part D plan |
| Extra Benefits (Dental, Vision, Hearing) | Usually included | Not included |
| Travel Coverage | Limited to U.S. or emergencies | More flexibility for travelers |
Get your free Medicare supplement quote today!
Get My QuotePros and Cons of Each Plan
✅ Medicare Advantage Pros
- Lower monthly premiums
- Includes extra benefits (dental, vision, hearing)
- Prescription drug coverage is often included
❌ Medicare Advantage Cons
- Limited provider networks
- Higher out-of-pocket costs
- Requires referrals for specialists (HMO plans)
✅ Medigap Pros
- Predictable healthcare costs
- No provider restrictions—see any doctor that accepts Medicare
- Lower out-of-pocket medical costs
❌ Medigap Cons
- Higher monthly premiums
- Does not cover prescriptions, vision, dental, or hearing
- Requires separate Medicare Part D plan for drugs
Which Plan is Right for You?
✅ Choose Medicare Advantage if:
- You want a lower monthly premium
- You need extra benefits (dental, vision, Rx coverage)
- You’re okay with network restrictions
✅ Choose Medigap if:
- You want freedom to choose any doctor
- You prefer lower out-of-pocket medical costs
- You don’t mind paying higher monthly premiums
Frequently Asked Questions
🟢 Can I switch from Medicare Advantage to Medigap?
Yes, but you may need medical underwriting unless you qualify for a Special Enrollment Period.
🟢 Does Medigap cover prescription drugs?
No, you need a separate Medicare Part D plan for prescription drug coverage.
🟢 Which is cheaper in the long run?
Medicare Advantage has lower upfront costs, but Medigap saves more on out-of-pocket medical expenses.
🟢 Can I have both Medicare Advantage and Medigap?
No, you cannot have both. You must choose one.
🟢 Does Medigap cover long-term care?
No, neither plan covers long-term care; you’ll need separate long-term care insurance.
🟢 Will I need a referral for specialists with Medicare Advantage?
HMO plans require referrals, but PPO plans do not.
🟢 Which plan is better for travelers?
Medigap is better for travelers since it covers any doctor nationwide that accepts Medicare.
🟢 Are there enrollment periods for Medigap?
Yes, the best time to enroll is during the Medigap Open Enrollment Period (first 6 months after enrolling in Medicare Part B).
Compare Medicare Advantage Plans Near You!
Schedule a Call📌 Related Articles
📖 Pillar Article: Medicare Advantage Overview & Comparison
📍 Other Cluster Articles:
