Choosing between Medicare Advantage and a Medigap plan can be confusing. Both options help cover healthcare costs not fully paid for by Original Medicare, but they do so in very different ways. This guide breaks down the pros and cons of each to help you find the right fit based on your needs, budget, and lifestyle.

What is Medicare Advantage?

Medicare Advantage (Part C) is an alternative to Original Medicare. These plans are offered by private insurance companies and bundle Part A and Part B together, often including Part D (prescription drug coverage) and extra benefits like dental, vision, or fitness programs (Centers for Medicare & Medicaid Services [CMS],2024).

Pros of Medicare Advantage:

• • Often includes prescription drug coverage (Part D)
  • May include extras like dental, vision, hearing, or wellness benefits
  • Usually has a lower monthly premium than Medigap plans
  • All-in-one coverage from a single insurer

Cons of Medicare Advantage:

• • Requires staying within a provider network (HMO or PPO)
  • Copays and coinsurance can add up for frequent care
  • May require prior authorization for certain procedures or referrals to see specialists

What is Medigap?

Medigap, also known as Medicare Supplement Insurance, helps pay out-of-pocket costs not covered by Original Medicare–like deductibles, coinsurance, and copayments. These plans are also sold by private insurance companies but work alongside your Original Medicare coverage (CMS, 2024). 

Pros of Medigap:

• • Allows you to see any provider that accepts Medicare (no networks)
  • More predictable out-of-pocket costs
  • No referrals required to see specialists
  • Good for people two travel frequently or want flexibility

Cons of Medigap:

• • Typically has a higher monthly premium than Medicare Advantage
  • Does not include Part D, so you’ll need to buy a separate prescription plan
  • Limited enrollment periods may require medical underwriting if you miss your initial window.

Which One Should you Choose?

There’s no one-size-size-fits-all answer. Medicare Advantage might be better for you if you’re looking for low monthly premiums, don’t mind provider networks, and want extras like dental or vision. On the other hand, if you value flexibility and travel often–or want to limit surprise medical costs–Medigap may be the better option.

Still Unsure?

Talking with one of our agents at Harbor Health Insurance Services can help you weigh your priorities and choose confidently. 

References:

Centers for Medicare & Medicaid Services. (2024). Medicare & You 2024. U.S. Department of Health and Human Services. http://www.medicare.gov/publications

Medicare Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.