What is the main difference between Medicare Advantage and Medigap?

Medicare Advantage (Part C) replaces Original Medicare with a private plan that bundles A, B, and usually D — with networks, copays, and an annual out-of-pocket maximum. Medigap (Medicare Supplement) works alongside Original Medicare to fill the cost gaps (deductibles, coinsurance, copays) while keeping the freedom to see any Medicare-accepting provider nationwide.

Is Medigap or Medicare Advantage cheaper?

It depends on your health and usage. Medicare Advantage plans often have lower monthly premiums (many are $0 beyond your Part B premium), but you pay copays when you use care. Medigap plans have higher monthly premiums but can reduce or eliminate cost-sharing at the time of service, making total annual costs more predictable for people who use a lot of healthcare.

Can I switch from Medicare Advantage to Medigap later?

Technically yes, but it's not guaranteed. Outside your Medigap open-enrollment window (the 6 months starting when you turn 65 and enroll in Part B), most states allow insurers to use medical underwriting — meaning they can charge more or deny coverage based on your health history. If you're in good health, you may qualify; if not, you could be locked out of comprehensive Medigap coverage.

Do Medicare Advantage plans cover dental, vision, and hearing?

Most Medicare Advantage plans offer some dental, vision, and hearing benefits beyond what Original Medicare covers. Coverage varies widely by plan — some include routine dental cleanings and eye exams while others cover major dental work or hearing aids. Always review the Summary of Benefits for the specific plan before enrolling.

What does Medicare Advantage not cover that Medigap does?

The most significant difference is provider flexibility. Medigap allows you to see any provider who accepts Medicare, anywhere in the U.S. — no referrals, no network restrictions. Medicare Advantage plans use networks (HMO or PPO), and going out of network can cost significantly more or be excluded entirely. Medigap also has no network restrictions for travel or snowbirds who split time between states.

Medicare Planning · Price Services Group, L.L.C.

Medicare Advantage vs. Medigap in 2026: which is right for you?

Two paths through Medicare — one bundles everything into a private plan, the other fills Original Medicare's gaps. The right answer depends on your health, your doctors, and a time-sensitive enrollment window most people don't know about.

Kayla Price, licensed Medicare advisor at Price Services Group, L.L.C.

Price Services Group Data Desk

Published June 20, 2026 · 10 min read · Sourced from CMS.gov

The bottom line

Medicare Advantage bundles your Medicare into a private plan with networks, copays, and often extra benefits like dental and vision — usually at a lower monthly premium.
Medigap (Medicare Supplement) pays Original Medicare's cost-sharing gaps, giving you the freedom to see any Medicare-accepting provider anywhere, with predictable out-of-pocket costs.
The biggest gotcha: you have a one-time, 6-month Medigap open-enrollment window when you're guaranteed acceptance at standard rates. After that, insurers can medically underwrite (and deny) you in most states.
There is no universally "better" choice — it depends on your health, budget, and how you use healthcare.

Every year, millions of people turning 65 face the same fork in the road: Medicare Advantage or Medigap? Both cover your Medicare benefits. Both cost money. But they work in completely different ways — and once you choose, switching can be complicated, expensive, or in some cases impossible.

Side-by-side: the key differences

Feature	Medicare Advantage (Part C)	Medigap (Medicare Supplement)
Monthly premium	Often $0–$50 (beyond Part B)	$100–$300+ depending on plan and age
Provider network	HMO/PPO network required	Any Medicare-accepting provider nationwide
Referrals needed	Usually yes (HMO) / No (PPO)	Never
Out-of-pocket maximum	Yes — capped annually by CMS	Varies by plan; Plan G caps most costs
Prescription drugs	Usually included (MA-PD)	Need separate Part D plan
Dental / vision / hearing	Often included (varies by plan)	Not included — need separate coverage
Travel / out-of-state care	Limited to network (except emergencies)	Covered anywhere Medicare is accepted
Underwriting to enroll	No — guaranteed issue	No during open-enrollment window; yes after

Source: CMS Medicare Advantage landscape · Medicare.gov Medigap.

How Medicare Advantage works

When you enroll in a Medicare Advantage plan, you're still in Medicare — but a private insurer approved by CMS takes over delivering your benefits. The insurer gets paid a monthly capitation rate from CMS and manages your care through its network.

What that means in practice:

You typically pay a $0–$50/month premium on top of your Part B premium
You see doctors in the plan's network — and pay copays at the time of service
Most plans include Part D drug coverage, so you don't need a separate drug plan
Your total out-of-pocket costs are capped annually (CMS sets a maximum each year)
Many plans add extras Original Medicare doesn't cover: routine dental, eye exams, hearing aids, fitness programs, and transportation

The tradeoff: Networks. In an HMO plan, you generally must use in-network providers and get referrals to see specialists. In a PPO, you can go out of network but pay more. If your doctor or hospital isn't in the plan's network, you could face significantly higher costs — or have to change providers.

Always check the network first. Before enrolling in any Medicare Advantage plan, confirm that your primary care doctor, specialists, and preferred hospital are in that plan's network for the coming plan year.

How Medigap works

Medigap (Medicare Supplement) is a private insurance policy that works alongside Original Medicare — not instead of it. You stay in Original Medicare (Parts A and B), and your Medigap plan picks up some or all of the costs Medicare doesn't pay: deductibles, coinsurance, and copays.

Medigap plans are standardized by CMS into lettered plans (A, B, D, G, K, L, M, N). The benefits within each letter are identical across insurers — a Plan G from one company covers the same things as Plan G from any other. The only differences are premium price and company reputation.

Plan G is currently the most comprehensive plan available to new Medicare enrollees (Plan F, which covered the Part B deductible, is no longer available to people who became eligible after January 1, 2020). With Plan G, after you meet the Part B deductible, you typically owe nothing for Medicare-covered services.

Medigap does not include:

Prescription drug coverage — you need a separate standalone Part D plan
Dental, vision, or hearing coverage
Long-term care

The enrollment window you can't miss

Here's the detail most people don't learn until it's too late: your Medigap open-enrollment window is a one-time 6-month period that starts the month you turn 65 and are enrolled in Part B. During this window, insurers must sell you any Medigap plan at standard rates — they cannot deny you or charge more based on your health history.

After that window closes, most states allow medical underwriting. That means insurers can review your health history, charge higher premiums, or deny you coverage. If you develop a serious condition after 65 and then try to get Medigap, you may find it unaffordable or unavailable.

months — your guaranteed Medigap open-enrollment window

additional cost-sharing after Part B deductible with Plan G

$2,100

annual Part D out-of-pocket cap for 2026

This asymmetry is why many advisors recommend making the Advantage vs. Medigap decision thoughtfully at 65 rather than defaulting to whichever plan seems cheaper that month.

Who tends to do well with each option

Medicare Advantage may be a better fit if you:

Are relatively healthy and don't use a lot of healthcare services
Want the lowest possible monthly premium
Want extras like dental, vision, and hearing in one plan
Are comfortable with a provider network and coordinated care
Stay primarily in one geographic area

Medigap may be a better fit if you:

Have chronic conditions or expect to use significant medical services
Want the freedom to see any Medicare-accepting provider, anywhere
Travel frequently or split time between states
Value predictable, capped out-of-pocket costs
Want to avoid referrals and prior authorization requirements

Not sure which path is right for your situation?

Kayla Price at Price Services Group, L.L.C. compares both options against your doctors, prescriptions, and budget — free, no pressure. We do not offer every plan available in your area.

Schedule a free comparison →

Sources: Medicare.gov Medigap · CMS Medicare Advantage landscape. Price Services Group, L.L.C. is an independent licensed agency — we do not offer every plan available in your area.