Published: November 5, 2023
Category: Medicare
Choosing between Medicare Advantage and Medicare Supplement (Medigap) is one of the most important healthcare decisions you'll make. Both options help fill gaps in Original Medicare, but they work very differently. Let's break down the key differences to help you choose.
Quick Overview
| Feature | Medicare Advantage | Medicare Supplement |
|---|---|---|
| How it works | Replaces Original Medicare | Works with Original Medicare |
| Network | Usually HMO or PPO | Any Medicare provider |
| Prescription drugs | Often included | Separate Part D needed |
| Extra benefits | Dental, vision, hearing | None |
| Monthly premium | $0 - $200+ | $100 - $400+ |
Medicare Advantage (Part C)
Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare covers, but often include additional benefits.
Pros of Medicare Advantage:
- Lower monthly premiums (many $0 premium plans)
- Extra benefits like dental, vision, hearing
- Prescription drug coverage usually included
- Out-of-pocket maximum protects from catastrophic costs
- Gym memberships and wellness programs
Cons of Medicare Advantage:
- Network restrictions (HMO/PPO)
- Referrals often required for specialists
- Prior authorization for many services
- Limited coverage when traveling
- Plans can change annually
Medicare Supplement (Medigap)
Medicare Supplement plans help pay for costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles. These plans are standardized and labeled with letters (A, B, C, D, F, G, K, L, M, N).
Pros of Medicare Supplement:
- Freedom to see any Medicare-accepting doctor
- No referrals needed for specialists
- Coverage travels with you nationwide
- Predictable costs with little to no surprises
- Some plans cover foreign travel emergencies
- Guaranteed renewable (can't be canceled)
Cons of Medicare Supplement:
- Higher monthly premiums
- No prescription drug coverage (need Part D)
- No extra benefits (dental, vision, etc.)
- Premiums increase with age
- May require medical underwriting after initial enrollment
Cost Comparison
Typical Monthly Costs:
Medicare Advantage:
Premium: $0-$200 + Part B premium ($174.70 in 2024)
Plus copays/coinsurance when you use services
Medicare Supplement:
Premium: $100-$400 + Part B premium + Part D premium ($30-$100)
Little to no additional costs when you use services
Who Should Choose Medicare Advantage?
Medicare Advantage might be right for you if:
- You're healthy and don't see doctors often
- You want lower monthly premiums
- You value extra benefits like dental and vision
- You're comfortable with network restrictions
- You don't travel frequently
- You want prescription coverage in one plan
Who Should Choose Medicare Supplement?
Medicare Supplement might be better if:
- You have chronic health conditions
- You see specialists regularly
- You travel frequently
- You want maximum flexibility in choosing doctors
- You prefer predictable healthcare costs
- You can afford higher monthly premiums
⏰ Important Timing
You have a 6-month Medigap Open Enrollment Period when you first enroll in Medicare Part B. During this time, you can't be denied coverage or charged more due to health conditions.
You can switch from Medigap to Medicare Advantage during any Annual Enrollment Period, but switching back may require medical underwriting.
Making Your Decision
Consider these factors when choosing:
- Your health status: Current conditions and family history
- Your budget: Both monthly premiums and potential out-of-pocket costs
- Your doctors: Whether they're in-network for Advantage plans
- Your lifestyle: Travel habits and desire for flexibility
- Your priorities: Lower costs vs. more freedom
Get Expert Help Choosing
The choice between Medicare Advantage and Medicare Supplement is personal and depends on your unique situation. Our licensed advisors can help you compare options and find the best fit.