What it is
A Medicare Advantage comparison looks at two paths. One path is Original Medicare plus a Medigap plan, often with a separate Part D plan for drugs. The other is a Medicare Advantage plan (Part C), which is offered by private insurers and replaces Original Medicare's day-to-day coverage.
Medigap plans are standardized supplements. They help pay some of the costs Original Medicare leaves behind. You can generally see any provider nationwide that accepts Medicare, with no network and no referrals. Cost-sharing tends to be predictable. Trade-offs include generally higher monthly premiums, possible medical underwriting outside open enrollment or guaranteed issue, a separate drug plan, and no routine dental, vision or hearing.
Medicare Advantage plans bundle coverage into one plan. Many have lower monthly premiums, an annual out-of-pocket maximum, extra benefits and drug coverage. Trade-offs can include provider networks, prior authorization, referrals and copays. Plans differ by area and carrier, so details matter. Massachusetts, Minnesota and Wisconsin standardize Medigap differently, and other rules vary by state.
How it’s traditionally been approached
Many people start by asking what matters most to them. Some value choice of doctors and hospitals anywhere in the country. Others value lower monthly costs and added benefits in one package. Both are reasonable starting points.
Traditionally, people list their doctors, hospitals, prescriptions and travel habits. Then they check whether each option fits. With Advantage plans, that often means confirming networks and referral rules. With Medigap, it often means choosing a plan letter and a separate drug plan.
Plan letters need care. Only Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible for Medicare. Plans C and F (and high-deductible F) are available only to people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today, even though people still search for Plan H.
How the right licensed agent may help
A Medigap agent may help you lay the options side by side in plain language. A licensed agent can often explain how Medigap plans and Medicare Advantage plans differ, and what each may mean for your doctors and your budget. An agent can't promise a result or say one plan is best.
A first conversation is usually relaxed. You may be asked about your doctors, medications, health needs, location and when you became eligible. Agents may also explain enrollment timing, since open enrollment, guaranteed issue and birthday or anniversary rules vary by state and change over time.
Helpful questions to ask: Which of my doctors and hospitals are covered? Do I need referrals? How does cost-sharing work if I need a lot of care? What happens if I want to switch later? Could I face medical underwriting? Call 1-800-MEDIGAP for more information.
The bigger picture
Choosing between Medigap and Medicare Advantage is about more than paperwork. It touches your finances, your access to trusted doctors and your peace of mind. Some people feel calmer with predictable costs and broad choice. Others feel calmer with a lower premium and extra benefits in one plan.
Take your time and ask for help if you feel overwhelmed. Your health, budget and comfort with change all count. If you're also looking for care providers, Providers.plus may be a helpful resource. Confirm current rules with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent.
Keep in mind
- 1-800-MEDIGAP is an independent educational directory, not Medicare.gov, CMS, Social Security or any government agency, and is not endorsed by the federal government.
- This page is insurance education only, not insurance, legal, tax or medical advice.
- Costs, benefits, networks and enrollment rules change every year and vary by carrier, state and age, so confirm details before you decide.
- No plan is guaranteed to be available to you or to be best for you. Official information is at Medicare.gov.
Licensed agents
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Frequently asked questions
Is Medigap or Medicare Advantage better?
Neither is better for everyone. Medigap offers broad provider choice and predictable cost-sharing, but premiums are generally higher. Medicare Advantage often has lower premiums and extra benefits, but may use networks and prior authorization. Your doctors, health needs and budget shape the fit.
Can I have Medigap and Medicare Advantage at the same time?
Generally, no. Medigap is designed to work with Original Medicare, not with a Medicare Advantage plan. If you're thinking of switching, confirm the timing and your options with Medicare.gov, your SHIP or a licensed agent first.
Do I need referrals with Medigap or Medicare Advantage?
With Medigap, you generally don't need referrals to see specialists who accept Medicare. Medicare Advantage plans may require referrals or prior authorization, depending on the plan type. Check the specific plan's rules before enrolling.
What extra benefits does Medicare Advantage offer?
Many Medicare Advantage plans include extras such as dental, vision, hearing or drug coverage. Benefits vary by plan and area. Medigap plans generally don't cover routine dental, vision or hearing, and drugs need a separate Part D plan.
Can I switch between Medigap and Medicare Advantage later?
Sometimes, but rules vary. If you move to Medigap outside open enrollment or guaranteed issue, medical underwriting may apply in some cases, and acceptance isn't guaranteed. Confirm current rules for your state with Medicare.gov, your SHIP or a licensed agent.
How do I compare Medicare options for my situation?
Start by listing your doctors, prescriptions, hospitals and travel needs. Then compare how each option handles them. A Medigap agent may help you compare Medicare options. Call 1-800-MEDIGAP for more information.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.