Medicare Advantage vs Medigap: Which Is Right for You?

The biggest choice most people make when they join Medicare is between two very different paths: a Medicare Advantage plan, or Original Medicare with a Medigap (Medicare Supplement) policy. Both are legitimate and both are popular. They differ in how you pay, which doctors you can see, and how easy it is to change your mind later. This guide compares them side by side so you can see which one fits the way you use health care.

Key takeaways

• Medicare Advantage (Part C) replaces how you receive your Medicare benefits through a private plan with a network, copays, and a yearly out-of-pocket limit.
• Medigap works alongside Original Medicare and pays some of your share of costs. It has a monthly premium but no network.
• You cannot have both at the same time.
• Your first Medigap enrollment window is the easiest time to get a policy. Later, most states allow health questions.
• Switching is possible, but the rules and timing differ in each direction.

How Medicare Advantage works

Medicare Advantage plans are offered by private insurance companies approved by Medicare. When you join one, you still have Medicare, but the plan manages your Part A and Part B benefits and usually includes Part D drug coverage.

Key features:

• Networks. Most plans are HMOs or PPOs. HMOs generally require you to use network providers and may require referrals. PPOs let you go out of network, usually at a higher cost.
• Cost structure. Many plans have a low or even no premium beyond your Part B premium. You pay copays or coinsurance as you use services.
• Out-of-pocket maximum. Every plan sets a yearly limit on what you pay for covered Part A and B services. CMS sets the highest allowed limit each year, and plans can set theirs lower.
• Extra benefits. Many plans include dental, vision, hearing, or fitness benefits that Original Medicare does not cover. The details vary a lot by plan.
• Plan rules. Prior authorization for certain services is common, and the plan's network and benefits can change every year.

By law, a Medicare Advantage plan must cover everything Original Medicare covers (except hospice, which stays with Original Medicare). What changes is how you access it and what you pay.

How Medigap works

Medigap is a supplement, not a replacement. You keep Original Medicare, and Medicare pays its share first. Then the Medigap policy pays some or all of what is left, depending on the plan you choose.

Key features:

• Standardized plans. Medigap plans are labeled by letter (such as Plan G or Plan N), and a given letter offers the same basic benefits from every insurer in most states. Massachusetts, Minnesota, and Wisconsin standardize their plans differently. Plans C and F are not available to people who became eligible for Medicare on or after January 1, 2020.
• No network. You can see any doctor or hospital in the country that accepts Medicare. No referrals are needed.
• Monthly premium. You pay the Medigap premium in addition to your Part B premium. Premiums vary by insurer, plan letter, location, and sometimes age.
• Predictable costs. With the more comprehensive plans, your out-of-pocket costs for covered services are small and predictable.
• No drug coverage. You need a separate Part D plan.
• No extras. Medigap does not add dental, vision, or hearing benefits.

Side-by-side comparison

Who Medicare Advantage tends to fit

Medicare Advantage often appeals to people who:

• Want a lower monthly premium and are comfortable paying copays as they go
• Have doctors and hospitals that are in the plan's network
• Value bundled drug coverage and extras like dental or vision
• Stay mostly in one area and do not need routine care in other states
• Are comfortable with network rules and prior authorization

The trade-off is less flexibility. If your health needs change and you want to move to Medigap later, you may need to pass medical underwriting.

Who Medigap tends to fit

Original Medicare with Medigap often appeals to people who:

• Want the freedom to see any Medicare provider without referrals
• Travel often or split time between states
• Prefer a predictable monthly cost over variable copays
• Have ongoing health conditions and want to minimize surprise bills
• Want to lock in coverage during their initial window while no health questions are asked

The trade-off is a higher fixed monthly cost, plus the need to buy a separate Part D plan.

The windows that matter

Your first chance: the Medigap open enrollment period

When you are 65 or older and first enrolled in Part B, you get a six-month window to buy any Medigap plan sold in your state without medical underwriting. This window does not repeat. It is the single most important timing rule in this decision, and the turning 65 Medicare checklist walks through it.

Annual Enrollment Period (October 15 to December 7)

Each fall, you can join, drop, or switch Medicare Advantage and Part D plans. Changes take effect January 1. This is also when you can leave Medicare Advantage and return to Original Medicare.

Medicare Advantage Open Enrollment Period (January 1 to March 31)

If you are already in a Medicare Advantage plan, you can make one change: switch to a different Medicare Advantage plan, or return to Original Medicare and pick up a Part D plan.

Guaranteed issue rights for Medigap

In certain situations, insurers must sell you a Medigap policy without health questions even outside your open enrollment period. Common examples include:

• Trial right: You joined Medicare Advantage when you first became eligible at 65 and leave within the first 12 months.
• Second trial right: You dropped a Medigap policy to try Medicare Advantage for the first time and leave within 12 months.
• Plan leaves your area or Medicare ends its contract with the plan.

Some states add protections, such as birthday rules or yearly windows. Check with your state Department of Insurance or a licensed agent in your state.

Switching in each direction

From Medigap to Medicare Advantage: Enroll in a Medicare Advantage plan during AEP (or another valid window), then cancel your Medigap policy by contacting the insurer. Do not cancel Medigap until your Medicare Advantage enrollment is confirmed.

From Medicare Advantage to Medigap: Disenroll from Medicare Advantage during AEP or the MA OEP, enroll in a standalone Part D plan, and apply for Medigap. Unless you have a guaranteed issue right, the Medigap insurer can ask health questions and may decline you or charge more in most states.

Because of that asymmetry, many people treat the Medigap decision as a "decide once" choice and think carefully about it during their first window.

How to decide

1. List your doctors and confirm which Medicare Advantage networks include them.
2. List your prescriptions and compare drug costs across plans on Medicare.gov's Plan Finder.
3. Estimate your costs in a healthy year and in a difficult year under each option.
4. Think about travel and where you might live in five years.
5. Check current premiums and out-of-pocket limits for your county on medicare.gov.
6. Talk to a licensed agent who sells both types of coverage, so you hear the trade-offs honestly. Our guide to choosing a Medicare agent shows what to ask.

Talk to a licensed agent for free

Licensed Medicare agents are paid by the insurance carriers whose plans they sell, so you pay nothing extra, and your premium is the same whether you enroll through an agent or on your own. An agent who offers both Medicare Advantage and Medigap can compare real plans in your county against your doctors, prescriptions, and budget, and explain the switching rules for your state. You can browse Medicare agents by state, such as Florida, or find a licensed health insurance agent near you at no cost.