Medicare Advantage vs Medigap

Learn all about the major differences between a Medicare Advantage Plan and a Medigap Plan (Medicare Supplement Insurance) and the pros and cons of each.

Medicare Advantage Plans and Medigap plans cannot be combined. Medigap is intended to be used as a supplement to Original Medicare. It is against the law for anyone to sell you a Medigap policy if you are enrolled in a Medicare Advantage Plan unless you are going back to Original Medicare.

Medicare Advantage Plans may have different policies, fees, and restrictions, but they must offer at least the same set of benefits as Original Medicare parts A and B. For example, Medicare Advantage Plans might require that you visit medical professionals in their network and/or obtain a prescription from your primary care physician before consulting specialists. Some Medicare Advantage plans provide additional, Medicare-exempt benefits like dental, hearing, fitness, transportation, and more. These plans are more structured like a typical health insurance plan, offering HMO, and PPO style plans.

A Medicare Supplement Plan (Medigap), provides supplementary coverage in addition to Original Medicare Parts A and B. Depending on where you reside and when you became Medicare eligible, You can select from up to ten different Medigap plans: A, B, C, D, F, G, K, L, M, and N. (Plans in Wisconsin, Massachusetts, and Minnesota have different names.)

Each lettered Medigap plan provides a unique set of benefits, but all plans with the same letter must provide the same benefits (regardless of the company through which you purchase it). Premiums vary based on the plan you select and the company you choose to purchase it from

Your remaining out-of-pocket expenses after Original Medicare has paid its portion can be covered in part or entirely by a Medigap plan. The Medigap "gap" originates from here. If Original Medicare does not provide the coverage you need, Medigap insurance may "fill in the gaps."


Original Medicaid Medicare Advantage Part C)
There is no annual cap on out-of-pocket expenses unless you have extra coverage, such as Medigap insurance. Plans have an annual cap (max out of pocket) on the amount of money you must pay out of pocket for procedures that Medicare Parts A and B cover. You won't be charged for any Part A and
To help with any leftover out-of-pocket expenses (like your 20% coinsurance), you can acquire Medigap. Or you can use Medicaid or insurance from a past employer, union, or another source. You are not able to buy and don’t need Medigap.
Medical care received outside the United States is typically not covered by Original Medicare. It's possible to purchase a Medicare Supplement Insurance (Medigap) plan that offers emergency medical coverage abroad. Healthcare outside of the United States is typically not covered by plans. When traveling outside of the United States, certain plans may provide a supplemental benefit that pays for

Now that we have a better picture of how Medigap works with Original Medicaid, let's have a look at how Medigap stacks up to MA. Medicare Advantage and Original Medicare are compared in the table below. Keep in mind that there are several sorts of plans.

Medigap Medicare Advantage
Cost-sharing After Original Medicare has paid its share, this plan pays a portion or all of the remaining expenditures. The cost-sharing varies according to the plan. Pay a copay for in-network care. Make certain to compare the cost-sharing of a certain plan to Original Medicare.
Premium In addition to the Part B payment, plans charge a monthly premium. In addition to the Part B payment, plans may charge a monthly premium.
Provider access See any provider and use any facility that accepts Medicare. Typically, only in-network providers are seen.
Referrals Normally not needed. Typically need a referral for a specialist.
Other benefits In most cases, it only covers Medicare cost-sharing. However, it may cover costs that Medicare does not cover, such as 365 extra lifetime days for hospital or treatment obtained when traveling overseas. Additional services, such as vision, hearing, and dental, may be covered (additional benefits may increase your premium or other out-of-pocket costs)
Enrollment The best time to enroll in a Medigap policy is during your open enrollment period. If you miss the open enrollment period, you can still purchase a Medigap policy if you have a guaranteed issue right. Choose a new Medicare Advantage Plan or switch between Original Medicare and Medicare Advantage during the Fall Open Enrollment Period (October 15 through December 7).

Medicare Advantage or Medigap–Which Should You Choose?

If you are in good health and have few medical bills, Medicare Advantage may be a useful and cost-effective option. However, if you have major medical issues that require expensive treatment and care, Medigap is usually preferable.

Consulting with a licensed insurance agent regarding your specific health situation can help determine which option is best for you. Since you can have both Medicare Advantage and Medigap at the same time, you must pick carefully to ensure you have adequate coverage for your individual circumstances.

The Pros of Medicare Advantage Plans

Monthly premiums for Medicare Advantage plans are often cheaper than those for Medigap policies. Prescription medicine coverage may also be included. If you choose Medigap, you must enroll in a separate medication plan.

Another significant advantage is that Medicare Advantage plans give additional coverage not accessible through standard Medicare. This can cover vision, hearing, and dental treatments, as well as gym memberships, preventative chiropractic care, and stipends for over-the-counter vitamins in some situations making the programs, especially appealing to recipients.

The Cons of Medicare Advantage Plans

One of the most significant downsides of a Medicare Advantage plan is that it restricts your ability to choose doctors, hospitals, and other health care providers. Medicare Advantage plans rely on health care provider networks; if you see a doctor or other provider who is not in your network, you will likely be required to pay a higher portion of the cost.

Because monthly premiums are sometimes low or nonexistent, many beneficiaries believe Medicare Advantage plans are less expensive options. However, the majority of the costs associated with Medicare Advantage plans are borne by copays, coinsurance, deductibles, and other out-of-pocket expenses incurred as part of the entire treatment process.

Some Medicare Advantage plans require patients to acquire prior approval or authorization before seeing a specialist, which is not always the case with Original Medicare.

The Pros of Medigap Plans

The most significant benefit of Medigap may be your choice of doctors. You have more options for physicians and hospitals since you may go to any provider who takes Medicare. While Medigap premiums are normally greater than those of Medicare Advantage, you will most likely have reduced out-of-pocket payments. You must evaluate how much you intend to pay for health care over the course of a year and compare it to your yearly premium cost.

Your insurance will automatically renew each year as long as you continue to pay your monthly payment. You don't need to change anything, but it's a good idea to review your plan and coverage every year to ensure it still matches your needs.

The Cons of Medigap Plans

Monthly premiums for Medigap policies are often greater than those for Medicare Advantage plans. You must also continue to pay your Medicare Part B monthly payments.

While you may apply for Medigap coverage at any time, you are not always guaranteed to be approved. You should join up during the Open Enrollment Period when you reach 65 for the greatest results. If you apply for coverage after the enrollment period has passed, you may be subject to medical underwriting and may be rejected coverage because to your age, medical history, or pre-existing diseases.

Plans are standardized in terms of coverage and benefits, but not in terms of cost or which plans are available in which states. Insurance companies that sell Medigap insurance are not required to provide every Medigap plan, and their prices may vary.

Can You Switch Between Medicare Advantage and Medigap?

If you sign up for Medicare Advantage and then decide it isn't for you, you can change to Medigap supplementary coverage. You can also change from Medigap to Medicare Advantage.

However, you must follow specific guidelines, and there may be complications if you wish to switch later. If you are enrolled in a Medicare Advantage plan, you can move to a different Medicare Advantage plan during the annual open enrollment period, which runs from October 15 through December 7.

You may also be unable to obtain Medigap coverage if you discontinue your Medicare Advantage plan. Insurers are obligated to offer you Medigap coverage if you are new to Medicare. However, there is no assurance that they would sell you one after the first enrolment.

When you move from a Medicare Advantage plan, insurers may charge you extra for Medigap coverage if you have major medical conditions.

Only a few states preserve your option to return to Original Medicare with Medigap coverage.

States That Allow You to Switch Year-Round

  • New York
  • Connecticut
  • Washington

States That Allow You to Switch During Enrollment Periods

  • California
  • Massachusetts
  • Maine
  • Missouri
  • Oregon

The rules governing your ability to switch differ across each of these states. You should consult your state's rules to see what applies in your situation.