Medicare Advantage vs Medigap: Which Plan Is Right For You?

Medicare Advantage vs. Medicare Supplement

Original Medicare (Parts A and B) covers most healthcare needs but leaves patients responsible for 20% of costs. This gap, with no annual cap, can be financially challenging in case of serious illness or injury.

To cover gaps in their coverage, many turn to Medicare Supplement or Medicare Advantage plans. NOTE: You can enroll in standalone Original Medicare OR Original Medicare AND a Medicare Supplement plan OR a Medicare Advantage plan. Before selecting a plan, ensure you don’t already have supplemental coverage through other sources like retiree health benefits or Tricare for Life.

Medicare Supplement and Medicare Advantage plans, offered by independent insurers, serve distinct purposes.

Medicare Supplement works alongside Original Medicare, covering a portion of claims after Medicare pays its share.

Conversely, Medicare Advantage replaces Original Medicare with standardized Medicare Part A and Part B. Regardless of choice, Part B premium remains payable.

Medicare Supplement, while potentially pricier, offers nationwide coverage, allowing freedom in choosing healthcare providers.

Medicare Advantage plans often feature lower premiums but operate within provider networks, restricting choices. While they cover the same benefits as Original Medicare, they may also offer top Medicare Advantage benefits.

Let’s dive deeper into each.

Medicare Supplement

Medicare Supplement (also known as Medigap): Bridges the coverage gaps in Original Medicare, including the 20% coinsurance in Part B and hospital coinsurance in Part A. Depending on the plan, it may cover deductibles and other expenses, even offering 80% coverage for emergency medical care abroad. These plans are labeled A, B, C, D, F, G, K, L, M, and N. This option may be beneficial to people who want the freedom to choose their own providers, such as specific doctors or hospitals.

Pros:

• No restrictions in choosing providers.
• Limited out-of-pocket costs.
• Nationwide coverage.

Cons:

• Premiums vary based on plan, timing, and insurer.
• Best purchased during a seven-month open enrollment period to avoid medical underwriting.
• Restrictions may apply for those under 65 with disabilities in some states.

Guaranteed Issue Rights ensure access to certain Medicare Supplement plans in specific situations, protecting against health-based discrimination.

Medicare Supplement Plans Comparison Chart

Key

• ✓ = Plan covers 100% of this benefit

• X = Plan does not cover this benefit

• % = Plan covers that percentage of the benefit

• N/A = Not applicable

Notes:

• *Plans F and G also offer a high-deductible option in some states. You must pay Medicare-covered costs up to $2,870 in 2025 before coverage begins.

• *Plans C and F are not available to people who became eligible for Medicare on or after January 1, 2020.

• For Plans K and L: After meeting your yearly out-of-pocket limit and Part B deductible, the plan pays 100% of covered services for the rest of the year.

• *Plan N pays 100% of Part B coinsurance, except for up to $20 copay for office visits and up to $50 copay for ER visits (if not admitted).

Medicare Advantage

Medicare Advantage integrates Medicare Parts A, B, and often D, offering additional benefits beyond Original Medicare. Commonly HMOs or PPOs, they set their cost-sharing structures and may require referrals for specialist visits.

Pros:

• Lower premiums.
• Flexibility to switch plans during enrollment periods.

Cons:

• Network restrictions may limit provider choices.
• Additional costs for out-of-network services.
• Copays for most services.

What Medigap Covers vs. What Medicare Advantage Covers

Switching between Medicare Advantage and Medicare Supplement is possible within defined periods and circumstances, but varying rules apply.

Deciding between the two depends on individual healthcare needs, financial considerations, and personal preferences.

When Medicare Advantage Makes Sense vs. When Medigap Might Be Better

Medicare Advantage may be better if you:

• Want lower or $0 monthly premiums.

• Prefer all-in-one coverage (A, B, D, extras).

• Are comfortable with provider networks.

• Want dental, vision, or hearing included.

Medigap may be better if you:

• Travel frequently or live in multiple states.

• Want the widest provider choice nationwide.

• Prefer more predictable out-of-pocket costs.

• Can afford higher premiums for broader coverage.

Enrollment Periods & Rights & Limitations

• Medicare Advantage Enrollment:

  • Initial Enrollment: When you first qualify for Medicare.

  • Annual Enrollment (Oct. 15 – Dec. 7): Switch, join, or drop plans.

  • Medicare Advantage Open Enrollment (Jan. 1 – Mar. 31): Switch MA plans or return to Original Medicare.

• Medigap Enrollment:

  • Medigap Open Enrollment: Six months after you enroll in Part B (no underwriting).

  • Outside this window, insurers may require medical underwriting.

  • Guaranteed Issue Rights apply in special cases (e.g., losing employer coverage).

Cost Comparison: Premiums, Out-of-Pocket, Prescription Drugs

Medicare Supplement (Medigap):

• Higher monthly premiums.

• Very low or no out-of-pocket at the point of service.

• Part D drug plan purchased separately.

Medicare Advantage:

• Often $0 or low premiums.

• Copays and cost-sharing apply, with an annual out-of-pocket maximum.

• Prescription drugs often bundled in (MAPD).

Next Steps

Ultimately, there’s no one-size-fits-all solution. Consult healthcare providers, evaluate financial aspects, and compare Medicare Advantage vs. Medicare Supplement plans to find the best fit. Reviewing supplemental benefits differences between MA and Medigap can help you decide whether broader provider access or bundled extras matter more for your situation.