Medigap vs Medicare Advantage Comparison (2024)

Medigap and Medicare Advantage are the main plan options available when you become eligible for Medicare. Depending on your situation and healthcare preferences, one plan will likely provide you with more value. We’re going to compare Medigap vs. Medicare Advantage this way. You can make the most informed decision regarding your health care.

Medicare Advantage vs. Medicare Supplement

Medigap and Medicare Advantage have many differences, including doctor networks, coverage benefits, and the need for referrals. Of course, the cost is different, but we’ll get to that.

A Medigap plan could be your ideal policy if you want coverage that gives you the most flexibility.

Medigap doctor network

When you have a Medicare Supplement, you can go to any doctor in the United States that accepts Medicare. Medigap policies especially benefit people who travel or want access to more doctors.

Also, some Medigap policies cover foreign travel emergency care up to the plan limits. Currently, Medicare doesn’t cover that type of incident.

Medicare Advantage doctor network

There are strict doctor networks with Medicare Advantage plans, especially HMO options. While the PPO option provides coverage for out-of-network doctors, the cost is substantially higher.

Medicare Advantage plans only cover you within the service area and don’t provide foreign travel emergency coverage.

Medicare Supplement coverage

Medicare Supplement coverage depends on the specific letter plan you select. Most plans cover the expenses Medicare would otherwise leave you to pay. Some plans offer a lower premium, and you cover the Part B deductible or pay a small copayment when you go to the primary care doctor.

Some plans cover skilled nursing facility coinsurance and Part B excess charges. There is coverage for the first 3 pints of blood each year and hospice coverage.

Also, Medigap plans cover up to an additional 365 days after Medicare Part A hospital benefits have been exhausted. All Medigap plans follow Medicare, so if Medicare approves a claim, the Medigap plan will approve.

Medicare Advantage coverage

Medicare Advantage plans are another way to receive your Medicare benefits. These plans take over your health coverage, and Medicare is no longer responsible for approving your claim. Instead, the Part C plan chooses whether to deny or approve your health care services.

Part C plans must be at least as good as Original Medicare. There are copayments or coinsurances whenever you go to a doctor, hospital, or health services where you use your insurance card. Often, there is no additional charge to switch from Original Medicare to a Medicare Advantage plan.

Sometimes these plans offer basic coverage for vision, hearing, and dental. But, if you need extensive dental work or vision coverage, a stand-alone policy could prove more beneficial.

Part C plans sometimes include silver sneakers or other senior fitness options.

Medigap vs. Medicare Advantage: Referrals

Medigap plans don’t require a referral. You can go to any doctor or specialist who accepts Medicare anytime. Medicare Advantage plans, especially the HMO plan options, require referrals.

A Medicare Supplement plan may be the best option if you don’t want to pay the primary care doctor to see the specialist.

Medigap or Medicare Advantage: Which is better?

While Medigap and Medicare Advantage plans are different, they can be beneficial. The policy that’s right for you depends on what’s important to you regarding your healthcare.

The benefits of a Medicare Supplement

Medigap policies are great because they allow you to see any doctor anytime, without hassle. Plus, since it works with Medicare to cover you, there are little to no costs when you visit the doctor.

A Medigap plan could be a huge money saver if you have severe medical conditions in your family. It’s better to have your insurance coverage before you need it.

Medigap plans can deny coverage if your health conditions become too severe and you’re not eligible for a Guaranteed Issue Right. It’s best to buy Medigap when you’re younger and healthier.

Medigap insurance allows you to enroll or change your plan anytime if you qualify medically.

If you’re okay with the freedom to see any doctor, predictable healthcare costs, and predictable coverage, then Medigap could work for you.

The benefits of Medicare Advantage

Medicare Advantage plans are great for healthy people. You may want a Part C plan for the basic dental, vision, or gym membership coverage. Sometimes these plans cover Part D prescriptions. So, yes, there are benefits to Part C.

But before deciding which option to choose, ensure you fully understand all sides. If you’re okay with strict doctor networks, higher out-of-pocket costs, and annual changes to coverage, Part C could work for you.

Medicare Advantage or Medicare Supplement: Which is cheaper?

It’s hard to determine which is cheaper when comparing Medigap vs. Medicare Advantage. Since costs and coverage on these two plans are apples to oranges, it will depend on what you anticipate your healthcare cost. Another factor is whether you want financial risk exposure or risk protection.

Medigap vs. Medicare Advantage premium

When it comes to premiums, Medigap is rightfully more expensive. Part C premiums are as low as $0; some options have Part B give-back options where you get money back. With insurance, you get what you buy.

The premium cost is only one factor when it comes to healthcare. Medigap costs more because the premium is the only thing you worry about. Depending on your policy, of course.

The cost of Medigap can range from $50-$300 a month, depending on where you live, your eligibility, the plan you choose, and other factors.

Medicare Supplement vs. Medicare Advantage maximum out-of-pocket

Most top Medigap plans don’t have a Maximum Out-of-Pocket (MOOP) because you don’t have much of an expense when you go to the doctor or the hospital. Depending on your plan, you might have no expenses outside your premium.

Medicare Advantage plans have a Maximum Out-of-Pocket because you pay for services every time you use your insurance card. With most Part C plans, the MOOP could be between $5,000 and $11,000, depending on the plans available in your service area.

The MOOP is the maximum amount you can spend on covered medical expenses before the plan covers you 100%. So, if you have a $ 300-a-month Medigap policy, you only pay $3,600 for the year, no matter how serious your health conditions become. You could pay $11,000 in health care costs if you have a Part C plan.

Now, with Part C, if you’re in good health or dodge the doctor, you could pay $0. Avoiding the doctor isn’t beneficial for your health, and when you get insurance, you want coverage that will provide value.

FAQs

Can I switch from Medicare Advantage to Medigap?

Yes, you can switch from Medicare Advantage to Medigap. Your situation determines the ideal times for you to make the switch.

When can I switch from Medicare Advantage to a Medicare Supplement?

If you signed up for Medicare Advantage when you first became eligible for Part B, and you’ve had your Part C for less than 12 months, you qualify for a “trial right” Guaranteed Issue (GI) Medigap plan. Also, if you had Medigap and switched to Part C less than 12 months ago, you could be eligible for the “trial right.”

In other instances, you may qualify for a Special Enrollment Period that gives you GI rights to sign up for Medigap.

Otherwise, you can wait until the Medicare Advantage Annual Enrollment Period to find a Medigap plan effective January 1 of the following year. If your Medigap plan is approved, you must cancel the Medicare Advantage plan. You can’t have both programs at the same time.

Can I switch from Medigap to Medicare Advantage?

You can change from a Medicare Supplement plan to a Medicare Advantage plan, but getting back on Medigap could be challenging. Before you change, make sure the switch is in your long-term best interest. Remember to enroll in a Medicare Advantage plan and have a qualifying enrollment period.

Which is more popular a Medicare Supplement or Medicare Advantage plan?

Our recent Medicare Satisfaction Survey shows that Medicare Advantage plans are slightly more popular than Medicare Supplement plans.

How to choose between Medicare Supplement vs. Medicare Advantage

If you’re struggling to choose between Medicare Advantage and Medigap, talking with a licensed Medicare expert is a great place to start. Our agents can help you determine which options make the most sense for your situation.

Some people will find Part C plans to provide them with the most value, and others will see more value in Medigap. Either way, having some coverage is always better than having no coverage.

To compare your options side by side, call us at the number above. If you prefer to compare your options online, fill out an online rate form now.

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Written By:

Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.

Reviewed By:

Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.