Medicare Advantage Plans vs Medigap

Navigating the world of Medicare might feel like a maze, with various options and plans available to suit different needs. Two common choices that might 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, this article will explore some of the key differences in Medicare Advantage plans vs Medigap, the coverage they could provide, and potential factors you should consider when selecting the best plan for your situation.


Key Takeaways



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


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Understanding Medicare Advantage and Medigap

Medicare Advantage and Medigap will likely be designed to supplement Original Medicare, but they differ in their potential coverage, costs, and provider networks. With Medicare Advantage, you get the same coverage as Original Medicare and might have additional advantages like dental, vision, and hearing care.

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


Exploring the Types of Medicare Advantage Plans

What is Medicare Advantage?

Medicare Advantage could act as an alternative to Original Medicare, offered by private health insurance companies. These plans could offer insurance plans that may provide a wide range of coverage for medical services.


Medicare advantage vs medicare supplement


Some of these plans may also include dental, vision, and hearing care. In addition to the standard benefits offered by Original Medicare, certain Medicare Advantage plans may include extra benefits like prescription drug coverage.

A popular type of Medicare Advantage plan will likely be 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 based on a preexisting condition.


What is Medigap?


aarp medicare supplement vs. advantage


Medigap, also known as Medicare Supplement Insurance, could be a supplemental insurance plan that may be designed to help fill some of the coverage gaps in Original Medicare.

Certain Medigap policies will likely be offered by private insurance companies, and they could cover expenses like deductibles, copayments, and coinsurances for various medical services.

When selecting a Medigap plan, members might want to consider the possible costs of the policy and the company’s reputation.

You may 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 potential differences in coverage.

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


Provider Networks

One difference between Medicare Advantage and Medigap will likely be their provider networks. Some of the Medicare Advantage plans may offer restricted provider networks, requiring you to utilize doctors and hospitals within the plan’s network to receive full coverage.

This might 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, some of the  Medigap plans may offer some of the following advantages:

  • No provider networks may allow you to visit any doctor or hospital that accepts Medicare


  • Flexibility for individuals with specific health requirements


  • Choice of healthcare providers


Possible Benefits

In terms of extra benefits, certain Medicare Advantage plans could potentially offer a more comprehensive package.


Medigap vs medicare advantage cost



Some of these plans could provide additional benefits such as:

  • Prescription drugs


  • Dental care


  • Vision care


  • Hearing care


Some Medicare Advantage plans may even include Part D drug coverage.

On the other hand, Medigap plans will likely be more focused on supplementing the coverage gaps that may be found in Original Medicare. While certain Medigap plans could provide additional benefits like vision, dental, and hearing services, these benefits might not be 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 will likely be the monthly premiums and out-of-pocket costs.


Monthly Premiums

Medicare Advantage could have lower monthly premiums than Medigap. This could potentially make it a more attractive option. The premium cost may vary each year and will likely depend on factors such as the type of plan, location, and other individual factors.

On the other hand, the Medigap premiums may 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

Certain Medicare Advantage plans might offer yearly out-of-pocket limits, which could help cap your healthcare expenses.


Medicare supplement plan g


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

This might ensure that beneficiaries may not be burdened with the cost of each medical appointment or hospital visit, and may allow for more manageable and predictable out-of-pocket expenses.

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Personal Factors to Consider

When deciding between Medicare Advantage and Medigap, members might want to consider some of 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 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 that may have costly treatment and care expenses, Medigap may be a more suitable option, as it could cover numerous out-of-pocket expenses that may be associated with obtaining frequent care.

Conversely, if you are looking for additional benefits that could offer low 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 may also 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, certain 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

Although switching between Medicare Advantage and Medigap is possible, 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 could start 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 likely not have the option to reinstate it, so make sure to weigh your options carefully before making a decision.


Both Medicare Advantage and Medigap could offer valuable benefits to supplement Original Medicare, but they differ in their coverage, potential costs, and provider networks.

Medicare Advantage may provide additional benefits like dental, vision, and hearing care, while Medigap will likely focus 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 potential 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?

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

Medigap will likely be a better choice for those with chronic illnesses or those who may need expensive medical procedures, while Medicare Advantage may be a better option for those looking for additional benefits such as prescription drugs, and vision, dental, and hearing services.


→  What are the advantages of a Medigap plan?

Some of the Medigap plans may be affordable, offer a broad range of plan coverage, and may cover long-term care services, potentially making them suitable for some individuals.


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

During your Initial Enrollment Period or the Medicare Advantage Open Enrollment, you can drop your Medicare Advantage Plan and go back to your 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 will likely offer extra benefits such as vision and dental care but might restrict your access to certain providers. Medigap, on the other hand, will likely focus on supplementing Original Medicare with certain coverage gaps and could allow 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.