Medicare Advantage Plans vs Medigap

Navigating the world of Medicare can feel like a maze, with various options and plans available to suit different needs. Two common choices that often spark a debate are Medicare Advantage and Medigap.

How do you choose between them, and which one is right for you? To answer these questions, we’ll dive into the key differences in Medicare Advantage plans vs Medigap, the coverage they provide, and the factors you should consider when selecting the best plan for your individual situation.


Key Takeaways



  • Personal health status, medical needs, lifestyle, and travel requirements should all be taken into account when making a decision between these two options.

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Understanding Medicare Advantage and Medigap

Medicare Advantage and Medigap are both designed to supplement Original Medicare, but they differ in their coverage, costs, and provider networks. With Medicare Advantage, you get the same coverage as Original Medicare, plus additional advantages like dental, vision, and hearing care.

On the other hand, Medigap is a customizable plan where you can acquire policies that provide specific types of coverage, helping to fill gaps in Original Medicare coverage.


Exploring the Types of Medicare Advantage Plans

What is Medicare Advantage?

Medicare Advantage is an alternative to Original Medicare, offered by private health insurance companies. It offers insurance plans that provide a wide range of coverage for medical services.


Medicare advantage vs medicare supplement


This includes but is not limited to, dental, vision, and hearing care. In addition to the standard benefits offered by Original Medicare, Medicare Advantage plans often include extra benefits like prescription drug coverage, fitness programs, and telehealth services.

One popular type of Medicare Advantage plan is the Medicare Advantage HMO, which offers a network of healthcare providers for enrollees to choose from.

To be eligible for Medicare Advantage, you must be enrolled in Medicare Part A and Part B and reside in the plan’s service area. Enrollment in Medicare Advantage plans is only permissible during specific periods; however, no individual shall be denied coverage on the basis of a preexisting condition.


What is Medigap?


aarp medicare supplement vs. advantage


Medigap, also known as Medicare Supplement Insurance, is a supplemental insurance plan designed to help fill coverage gaps in Original Medicare.

Medigap policies are offered by private insurance companies, and they can cover expenses like deductibles, copayments, and coinsurances for various medical services.

When selecting a Medigap plan, consider the cost of the policy and the company’s reputation.

You can purchase Medigap during the six-month period beginning the month in which you turn 65 and have obtained Medicare Part B.

Comparing Coverage: Medicare Advantage vs Medigap

When deciding between Medicare Advantage and Medigap, consider the differences in coverage.

Both options have their unique advantages, with Medicare Advantage offering extra benefits like dental, vision, and hearing care, while Medigap focuses on filling coverage gaps in Original Medicare.


Provider Networks

One key difference between Medicare Advantage and Medigap is their provider networks. Medicare Advantage plans have restricted provider networks, requiring you to utilize doctors and hospitals within the plan’s network to receive full coverage.

This can mean limited choices of physicians and medical facilities, as well as higher expenses for out-of-network providers.


Medigap vs medicare advantage consumer reports



In contrast, Medigap plans offer the following advantages:


  • No provider networks, allow you to visit any doctor or hospital that accepts Medicare
  • Flexibility for individuals with specific health requirements
  • Choice of healthcare providers


Extra Benefits

In terms of extra benefits, most Medicare Advantage plans often offer a more comprehensive package.


Medigap vs medicare advantage cost



These plans provide additional benefits such as:


  • Prescription drugs
  • Dental care
  • Vision care
  • Hearing care


Some Medicare Advantage plans even include Part D drug coverage.

On the other hand, Medigap plans are more focused on supplementing the coverage gaps found in Original Medicare. While certain Medigap plans do provide additional benefits like vision, dental, and hearing services, these benefits are not as extensive as those offered by Medicare Advantage plans.

Analyzing Costs: Medicare Advantage vs Medigap

When comparing Medicare Advantage and Medigap, consider the costs of each plan. Two key expenses to consider are monthly premiums and out-of-pocket costs.


Monthly Premiums

Medicare Advantage can have lower monthly premiums than Medigap. This can make it a more attractive option. In fact, many Medicare Advantage plans offer a $0 premium, though some plans may charge a monthly premium in addition to the Medicare Part B premium.

The amount of the premium can vary each year and depends on factors like the type of plan, your location, and other individual factors.

On the other hand, Medigap premiums can range from $150 to $200 per month. These premiums can vary depending on the specific plan and insurance company, so it’s important to shop around and compare costs when choosing a Medigap policy.


Out-of-Pocket Expenses

Medicare Advantage plans have yearly out-of-pocket limits, which can help cap your healthcare expenses. The out-of-pocket maximum for Medicare Advantage plans may differ, but the average limit is approximately $4,835 for in-network services and $8,659 for both in-network and out-of-network services.


Medicare supplement plan g



In contrast, Medigap can help make healthcare costs more predictable by covering some or all of your Medicare Part A and Part B copayments and deductibles.

This ensures that you are not burdened with the cost of each medical appointment or hospital visit, allowing for more manageable and predictable out-of-pocket expenses.

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Personal Factors to Consider

When deciding between Medicare Advantage and Medigap, consider the following factors:


  • Your health status
  • Your medical needs
  • Your lifestyle
  • Your travel requirements


Both options have their unique advantages, and the best choice for you depends on your individual situation.


Health Conditions and Medical Needs

Consider your specific health needs and medical care preferences when choosing between Medicare Advantage and Medigap.

If you have severe medical issues with costly treatment and care expenses, Medigap may be a more suitable option, as it can cover numerous out-of-pocket expenses associated with obtaining frequent care.

Conversely, if you are looking for additional benefits and often no monthly premiums, Medicare Advantage may be more appropriate. Ultimately, the choice depends on your individual health needs and preferences.


Lifestyle and Travel Considerations

Frequent travelers or those with dual residences may find Medigap more suitable due to its nationwide provider network. Certain Medigap policies offer coverage for emergency medical care when traveling outside of the United States.


Why do people choose medigap over medicare advantage



On the other hand, Medicare Advantage plans may have limited coverage outside of their network, which might not be ideal for those who travel frequently or have dual residences.

Switching Between Medicare Advantage and Medigap

Switching between Medicare Advantage and Medigap is possible, but there may be restrictions and potential loss of Medigap coverage depending on state regulations and enrollment periods.

If you transition to a Medicare Advantage plan and are not content, you possess a 12-month trial period to revert to Original Medicare and repurchase your prior Medigap policy.

However, be aware of the potential impact of discontinuing a Medigap policy. In most cases, you will not have the option to reinstate it, so make sure to weigh your options carefully before making a decision.


In conclusion, both Medicare Advantage and Medigap offer valuable benefits to supplement Original Medicare, but they differ in their coverage, costs, and provider networks.

Medicare Advantage provides additional benefits like dental, vision, and hearing care, while Medigap focuses on bridging coverage gaps in Original Medicare. When choosing between these options, it’s essential to consider your individual health needs, lifestyle, and travel preferences.

Ultimately, the decision between Medicare Advantage and Medigap is a personal one, and it’s crucial to evaluate all available options to find the best fit for your unique situation. By understanding the differences between these options and considering your individual needs, you can make an informed decision and select the most suitable plan for your healthcare journey.

Frequently Asked Questions



Is a Medigap plan better than an Advantage plan?

Medigap plans offer more flexibility with provider choice, but Medicare Advantage may offer an out-of-pocket maximum to protect from huge bills.

Medigap is generally better for those with chronic illnesses or those needing expensive medical procedures, while Medicare Advantage may be a better option for those looking for additional benefits such as prescription drugs, and vision, dental, hearing, and wellness services.


→  What are the disadvantages of a Medigap plan?

Medigap plans can be expensive, have coverage limitations, and don’t cover long-term care services, making them potentially unsuitable for some individuals.


→  Can I drop my Medicare Advantage Plan and go back to Original Medicare?

During your Initial Enrollment Period or during the Medicare Advantage Open Enrollment, you can drop your Medicare Advantage Plan and go back to Original Medicare. You need to contact your plan provider to disenroll, after which coverage will automatically revert to Original Medicare. No additional action is required on your part.


→  What are the main differences between Medicare Advantage and Medigap?

Medicare Advantage offers extra benefits such as vision and dental care but restricts you to certain providers. Medigap on the other hand focuses on supplementing Original Medicare with coverage gaps and allows visits to any Medicare provider.


→  Can I switch between Medicare Advantage and Medigap?

Yes, you can switch between Medicare Advantage and Medigap plans, although there may be certain restrictions and potential loss of coverage.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.