Medigap vs Medicare Advantage
Written by My65 Playbook Editorial Team
Last reviewed
This is the fork in the road for almost everyone turning 65. Both routes start from the same place — you enroll in Original Medicare — but they solve its gaps in opposite ways, and they are not equally easy to reverse. Choosing well is less about which plan looks cheaper this year and more about which trade-off you can live with for the next decade.
How to think about this
Strip away the brochures and the decision comes down to one question: would you rather pay more every month and almost nothing when you need care, or pay less every month and more at the point of service? Medigap buys predictability and the freedom to see any doctor who accepts Medicare. Medicare Advantage buys a lower monthly cost and bundled extras, in exchange for a network and, often, plan approval before certain care. Everything else follows from that.
At a glance
| What changes | Medigap (Medicare Supplement) | Medicare Advantage |
|---|---|---|
| Choosing your own doctors | Any doctor or hospital in the country that accepts Medicare. No network to check. | Generally limited to the plan's network. Going outside it costs more, or is not covered at all. |
| Seeing a specialist | Go directly. No referral required. | Many plans require a referral from your primary care doctor first. |
| How predictable your costs are | A higher, steady monthly premium, then very little when you actually use care. | A lower monthly premium, then copays and coinsurance as you go, capped by an annual out-of-pocket maximum. |
| Prescription drug coverage | Not included. You buy a separate Part D plan. | Usually built into the plan. |
| Care away from home | Works anywhere in the country Medicare is accepted, which matters if you travel or split the year between two states. | Routine care is generally tied to the plan's service area. Emergency care is covered anywhere. |
| Dental, vision and hearing | Not included. Bought separately if you want it. | Often bundled in, though the depth of coverage varies widely. |
| Changing your mind later | Guaranteed acceptance during your one-time Medigap open enrollment window. After that, you may have to answer health questions. | You can switch plans every year during the Annual Enrollment Period with no health questions asked. |
Medigap (Medicare Supplement)
- You want to keep a specific doctor or hospital system, or you split your year between two states.
- You would rather pay a known amount every month than face variable bills in the year you get sick.
- You expect ongoing or significant care and want as little cost as possible at the point of service.
- You want the option to travel without checking whether you are in network.
Medicare Advantage
- You want a lower fixed monthly cost and are comfortable paying as you use care.
- The doctors you already see are in the plan's network, and you do not travel much.
- You would rather have drug, dental and vision coverage bundled into one plan and one card.
- You are generally healthy and want to keep monthly costs down while you are.
Watch out for
- The door swings one way. You get one guaranteed window to buy Medigap without health questions, and it opens once. If you start with Medicare Advantage and want to move to Medigap years later, an insurer may be allowed to review your health and turn you down — and whether they can depends on the state you live in. That single asymmetry is the most consequential thing on this page.
- A plan advertised with no monthly premium is not free. You still pay your Part B premium, and you still pay copays and coinsurance as you use care until you reach the plan's annual out-of-pocket maximum.
- Networks are re-drawn every year. A doctor who is in network this year may not be next year, and plans are not required to keep the same hospitals. If you go the Medicare Advantage route, re-check your doctors each autumn rather than assuming.
- Some Medicare Advantage services need the plan's approval before you receive them. That is not unusual and not a scandal, but it is a real difference from Original Medicare with a Medigap policy, where approval is not part of the process.
Common questions
- Can I have both Medigap and Medicare Advantage?
- No. They are two different ways of solving the same problem, and the law does not let you hold both at once. If you enroll in a Medicare Advantage plan, a Medigap policy cannot be used to pay your costs.
- Do I still pay my Part B premium either way?
- Yes. Part B is the foundation both routes are built on, so you keep paying that premium whichever you choose. A Medigap policy is an additional premium on top of it; a Medicare Advantage plan may add little or nothing monthly, but replaces how your care is delivered and paid for.
- Can I switch from Medicare Advantage to Medigap later?
- Sometimes, but it is not guaranteed. Outside your one-time Medigap open enrollment window, insurers in many states may ask health questions and decline you. A handful of states are far more generous than the rest. Because this varies so much, it is worth confirming what applies where you live before you assume you can switch back.
- Does Medigap cover my prescriptions?
- No. Medigap covers gaps in Parts A and B only. If you go the Medigap route you will want a separate Part D plan, and it is worth enrolling on time — going without creditable drug coverage can create a permanent late-enrollment penalty.