Medigap vs Medicare Advantage: Side-by-Side

Medigap fills gaps in Original Medicare. Medicare Advantage replaces Original Medicare. Both exist, and your choice shapes what you pay, which doctors you can see, and your network flexibility.

What each plan type does

Medigap (supplemental) works alongside Original Medicare. You keep your Medicare doctor, and Medigap pays many of the costs Medicare doesn't — deductibles, copays, coinsurance, and out-of-network care.

Medicare Advantage replaces Original Medicare. You get a network-based plan (HMO, PPO, or PFFS) with an annual deductible, copays, and an out-of-pocket maximum, similar to employer health insurance.

Premiums and out-of-pocket costs

Medigap has a monthly premium (often $120–$300+) but typically low or no copays. Total cost depends on which Medigap plan (A through N) you choose and your usage.

Medicare Advantage typically has a lower or $0 premium but higher copays and an annual out-of-pocket maximum (often $5,000–$8,000). If you use a lot of care, costs stack up.

Provider choice and network limits

Medigap gives you choice — any doctor who accepts Medicare accepts your Medigap plan. No networks, no referrals, no prior authorization headaches.

Medicare Advantage restricts you to in-network providers (except emergencies). Out-of-network care may not be covered or costs far more. Some plans require referrals or prior authorization.

Which one makes sense for you

If you have significant health needs and want to keep your current doctors without network worry, Medigap is worth the premium. If you're healthy and want the lowest upfront cost, Medicare Advantage may fit.

Consider: Do you travel? Do you see specialists outside a potential network? Are you comfortable with copays stacking up? Will you stay in-network reliably? Your answers guide the choice.

Frequently asked questions

Can I have both Medigap and Medicare Advantage?

No. You choose one or the other. If you enroll in Medicare Advantage, your Medigap automatically terminates. If you drop Advantage, you may be able to re-enroll in Medigap.

What if I need care out of network with Medigap?

Medigap covers out-of-network care at the same rate as in-network. You have broad choice without network restrictions.

Does Medicare Advantage cover prescriptions?

Yes, most Medicare Advantage plans include Part D (drug coverage). Medigap does not — you buy Part D separately if you're on Original Medicare + Medigap.

Can I switch back to Medigap if I try Medicare Advantage?

Generally yes during AEP, but medical underwriting may apply depending on the plan and your age. Switching early (before age 65) is easier than switching later.

General educational information only, not medical or legal advice. Plan structures, networks, and costs vary by carrier and region and can change. Confirm all details directly with plans before enrolling.

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