Medicare Planning · Price Services Group, L.L.C.
Medicare Advantage vs. Medigap: compare coverage and costs
Compare coverage, total costs, provider rules, and the enrollment protections that may apply to your situation.
The bottom line
- Medicare Advantage provides Part A and Part B benefits through a private plan; network rules and costs vary, and some plans offer extra benefits.
- Medigap works with Original Medicare and pays specified cost-sharing according to the policy. Provider access and costs depend on Medicare rules and, for SELECT, policy restrictions.
- A key timing point: during your one-time, six-month federal Medigap Open Enrollment Period, an insurer cannot refuse to sell you a policy it offers, use medical underwriting to decide acceptance, deny coverage due to pre-existing conditions, or charge more because of those conditions. Other pricing factors may apply. Federal guaranteed-issue rights and state protections may apply in other situations.
- There is no universally "better" choice — it depends on your health, budget, and how you use healthcare.
Medicare Advantage and Original Medicare with Medigap are different ways to arrange coverage. Each has costs, rules, and enrollment rights that depend on your situation and timing.
Side-by-side: the key differences
| Feature | Medicare Advantage (Part C) | Medigap (Medicare Supplement) |
|---|---|---|
| Monthly premiums | Plan premium varies; continue any applicable Part B premium. | Compare the Part B premium, Medigap premium, and any separate Part D premium. |
| Provider access | Network and out-of-area rules vary by plan type and plan documents. | With Original Medicare, generally use providers who accept Medicare; SELECT policies may restrict providers. |
| Referrals and authorization | Requirements vary by plan and service; check plan documents. | Original Medicare usually does not require specialist referrals, but coverage rules still apply. |
| Medical out-of-pocket limit | The plan has an annual limit for covered Part A and Part B services, within the CMS maximum. | Benefits and any yearly limits depend on the standardized policy; Plan G does not pay the Part B deductible. |
| Prescription drugs | Many plans include Part D; check the specific plan. | Medigap does not include Part D; consider a separate drug plan. |
| Dental / vision / hearing | Some plans offer extra benefits; coverage and limits vary. | Standardized Medigap policies generally do not include these benefits. |
| Travel / out-of-area care | Coverage depends on plan rules; emergency and urgent-care protections apply. | Original Medicare generally covers eligible care from providers who accept Medicare; SELECT policies may have restrictions. |
| Health underwriting | No health-based underwriting for standard enrollment; SNP eligibility criteria apply | Generally barred during federal Open Enrollment and applicable protections; may apply otherwise |
Source: Medicare.gov coverage comparison · Medicare.gov Medigap benefits.
How Medicare Advantage works
When you enroll in Medicare Advantage, a private plan provides your Part A and Part B benefits under Medicare rules. You must have both Parts A and B to join. Network, cost-sharing, and service rules vary by plan.
What that means in practice:
- Plan premiums and cost-sharing vary; continue paying any applicable Part B premium.
- Network, out-of-network, referral, and cost-sharing rules depend on plan type and its documents.
- Many plans include Part D drug coverage; confirm whether the specific plan does.
- The plan has an annual limit for covered Part A and Part B services, subject to CMS limits; Part D costs have separate rules.
- Many plans add extras Original Medicare doesn't cover: routine dental, eye exams, hearing aids, fitness programs, and transportation
Review the plan's access rules: HMO, PPO, and other plan types differ in network, referral, and out-of-area coverage. Some plans cover certain out-of-network care at higher cost; others may not cover non-emergency out-of-network care. Confirm with the plan before enrolling.
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.
In most states, Medigap policies are standardized by letter, so policies with the same letter offer the same basic benefits regardless of insurer. Premiums, pricing methods, and availability can differ; state rules and eligibility affect which policies you can buy.
Read our Medicare Supplement details for more on Plan G, Plan N, and enrollment timing, or see how we compare plans we represent.
Plan G is one standardized option. Plan F generally is not available to people who first became eligible for Medicare on or after January 1, 2020. Plan G does not cover the Part B deductible; it may pay other specified cost-sharing for Medicare-covered services, subject to policy terms and Medicare coverage rules.
Medigap does not include:
- Prescription drug coverage — you need a separate standalone Part D plan
- Dental, vision, or hearing coverage
- Long-term care
Medigap Open Enrollment and other buying rights
Your federal Medigap Open Enrollment Period is a one-time six-month period beginning the first month you are 65 or older and enrolled in Part B. During this period, you can buy any Medigap policy sold in your state. An insurer cannot refuse to sell you a policy it offers, use medical underwriting to decide whether to accept your application, deny coverage due to pre-existing conditions, or charge more because of those conditions. Premiums may still vary for other reasons, such as age, location, or pricing method.
After this federal period, insurers may use medical underwriting in some situations. Separate federal guaranteed-issue rights and state protections can apply at other times. Depending on your circumstances and applicable protections, an insurer may be able to use health information when deciding whether to offer a policy or what to charge. Check with your State Insurance Department or SHIP before making a coverage change.
The standard Part D deductible and out-of-pocket threshold are $700 and $2,400, respectively, for 2027. Premiums and non-covered drugs do not count toward the threshold. See the CMS 2027 Rate Announcement and verify current plan terms.
Compare both paths using your own providers, prescriptions, expected services, budget, and enrollment rights. There is no universally best option.
Factors to compare
Consider how each option's rules fit your needs; these are comparison factors, not recommendations based on health status.
- Monthly premiums and expected medical and prescription costs
- Whether your specific providers participate or accept Medicare
- Network, referral, prior-authorization, and out-of-area rules
- Prescription coverage, formulary, and preferred pharmacies
- Extra benefits, eligibility requirements, limits, and participating vendors
- Medigap availability, underwriting, and protected buying rights
Not sure which path is right for your situation?
Kayla Price at Price Services Group, L.L.C. can help review the plans we represent against your doctors, prescriptions, and budget. We do not offer every plan available in your area.
Schedule a free comparison →Frequently asked questions
What is the main difference between Medicare Advantage and Medigap?
Medicare Advantage is a private way to receive Part A and Part B benefits; you must have both Parts A and B to join, and many plans include Part D. Medigap works only with Original Medicare and helps pay specified cost-sharing. With Original Medicare, you can generally use providers who accept Medicare nationwide, although Medicare SELECT policies may have provider restrictions.
Is Medigap or Medicare Advantage cheaper?
There is no universal cost winner. For Medicare Advantage, compare the plan premium, Part B premium, deductibles, copays, coinsurance, drug costs, and annual out-of-pocket limit. For Original Medicare with Medigap, compare the Part B and Part D premiums, Medigap premium, policy benefits, and costs Medigap does not cover. A $0 plan premium does not mean care is free.
Can I switch from Medicare Advantage to Medigap later?
You may be able to switch, but buying a Medigap policy outside your federal Open Enrollment Period depends on your circumstances. Federal guaranteed-issue rights and state protections may apply after certain events. Otherwise, an insurer may be able to use medical underwriting, subject to applicable law. Check your rights and deadlines with your State Insurance Department or SHIP before changing coverage.
Do Medicare Advantage plans cover dental, vision, and hearing?
Some Medicare Advantage plans offer extra dental, vision, or hearing benefits, but coverage and limits vary. Review the current Summary of Benefits and Evidence of Coverage for the specific plan.
What does Medicare Advantage not cover that Medigap does?
With Original Medicare, you can generally see providers nationwide who accept Medicare, subject to Medicare coverage rules. Standard Medigap policies help pay specified Original Medicare cost-sharing; Medicare SELECT policies may require designated providers for full benefits. Medicare Advantage network, referral, and out-of-area rules depend on the plan type and its documents.
Sources: Medicare.gov coverage comparison · Medicare.gov Medigap benefits · CMS CY 2027 Part D parameters. Price Services Group, L.L.C. is an independent licensed agency — we do not offer every plan available in your area.