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Medicare Made Simple
David Marsh · Licensed Agent

Medigap vs. Medicare Advantage

The two main ways to enhance your Medicare coverage — compared side by side so you can make the choice that's right for your lifestyle and health needs.

Medigap

Medicare Supplement Plans

Medigap (or Medicare Supplement Insurance) is private insurance that works alongside Original Medicare (Parts A & B). It fills in the "gaps" — covering some or all of the deductibles, coinsurance, and copayments that Original Medicare doesn't pay. You keep your Medicare card and use any provider that accepts Medicare nationwide.

Requires: Original Medicare (Parts A & B) + Medigap plan + separate Part D drug plan

Medicare Advantage

Part C Plans

Medicare Advantage is an all-in-one alternative to Original Medicare offered by private insurers. You receive all your Part A and Part B benefits through the plan, which often includes Part D and extra benefits like dental, vision, and hearing. Most plans use networks (HMO or PPO) with an annual out-of-pocket maximum.

Replaces: Original Medicare coverage (but you must still pay Part B premium)

Side-by-Side Comparison

Category
Medigap Supplement
Medicare Advantage
Monthly Premium
Higher — typically $100–$300/month depending on plan and age (plus Part B premium + Part D plan)
Often $0–$50/month extra (but you still pay Part B premium)
Out-of-Pocket Maximum
Effectively very low — Plan G covers almost everything after Part B deductible
Built-in cap (2026 max: $9,250 in-network, $13,900 combined) — but you can reach it
Provider Choice
Any doctor or specialist nationwide who accepts Medicare — no referrals needed
Restricted to plan network (HMO) or you pay more (PPO); referrals often required
Prescription Drug Coverage
Separate Part D plan required (additional cost)
Usually included in the plan at no extra premium
Extra Benefits (dental, vision, hearing)
Not included — must purchase separately
Often included — varies widely by plan
Prior Authorization
Not required — Medicare determines medical necessity
Required for many services and procedures
Travel / Nationwide Use
Excellent — accepted at any Medicare provider in the U.S.
HMO: limited to local network; PPO: nationwide but higher cost
Annual Plan Changes
Plan benefits are standardized and stable year to year
Plans change annually — premiums, networks, and benefits can all shift
Enrollment Flexibility
Guaranteed issue only during Medigap Open Enrollment (first 6 months of Part B); may face medical underwriting after that
Can switch plans annually during Annual Election Period (AEP) without medical underwriting. AEP October 15 - December 7 eath year
Best For
People who want comprehensive, predictable coverage and freedom to see any provider
People who want lower monthly costs, extra benefits, and are comfortable with a network

Standardized Medigap Plans

Medigap plans are standardized by the federal government — "Plan G" from one company offers the same benefits as "Plan G" from another. The differences are premium cost and company reputation. Plans C and F are no longer available to new Medicare enrollees (those eligible after January 1, 2020).

PlanHospital CoinsurancePart B CoinsurancePart A DeductibleSNF CoinsuranceForeign Travel
Plan A✓✓✗✓✗
Plan B✓✓✓✓✗
Plan GPopular✓✓✓✓✓
Plan NPopular✓✓ (copays apply)✓✓✓
Plan K✓ (50%)50%50%50%✗
Plan L✓ (75%)75%75%75%✗
✓ = Covered | ✗ = Not covered | Note: Plan G is generally the most popular for new enrollees after 2020. Plan N offers lower premiums in exchange for small copays ($20 for office visits, $50 for ER).

How Each Plan Type Works — Real Examples

Medigap Plan G — Example

Scenario: Robert, 66, has knee replacement surgery ($45,000 total)

Robert has Original Medicare + Medigap Plan G + standalone Part D plan. His Plan G premium is $250/month.

Total surgery costs$45,000
Medicare Part A pays (inpatient hospital)-$43,368
Medigap Plan G pays Part A deductible ($1,736)-$1,736
Robert pays Part B deductible (once per year)$283
Robert's total cost for this surgery$283

Plus his monthly premiums: $202.90 (Part B) + $250 (Plan G) + ~$25 (Part D) = ~$477.9/month or $5,734.80/annually.

Medicare Advantage (HMO) — Example

Scenario: Susan, 67, has knee replacement surgery ($45,000 total)

Susan has a $0-premium HMO Medicare Advantage plan with a $1,500 inpatient hospital copay, $6,700 annual out-of-pocket max, and Part D included.

Total surgery costs$45,000
Medicare Advantage plan pays-$43,500
Susan pays inpatient copay$1,500
Follow-up PT visits (20 × $30 copay)$600
Susan's total cost for this event$2,100

Plus her monthly Part B premium of $202.90 / monthly or $2,434.80 / annually (no additional plan premium). Annual out-of-pocket cap of $6,700 provides a financial ceiling (does not include premium).

Which Plan Is Better for You?

Consider Medigap if you:

  • Want complete freedom to see any Medicare provider
  • Travel frequently and want nationwide coverage
  • Have complex or chronic health conditions requiring specialists
  • Value predictable, stable costs year to year
  • Are in good health and can qualify during Medigap Open Enrollment

Consider Medicare Advantage if you:

  • Want to minimize monthly premiums
  • Would benefit from extra benefits (dental, vision, hearing, fitness)
  • Are comfortable with an in-network provider system
  • Prefer an all-in-one plan including drug coverage
  • Live in an area with strong plan networks

Not Sure Which Path Is Right for You?

The best plan depends on your health, your budget, your doctors, and your medications. David Marsh will compare real plans available in your area and give you a clear recommendation.

Get a Free Plan ComparisonContact David