Medicare Advantage vs. Medicare Supplement

When it comes to Medicare, you have important decisions to make about your healthcare coverage. One of the biggest choices is whether to enroll in a Medicare Advantage (Part C) plan or a Medicare Supplement (Medigap) plan. Both options help cover healthcare costs, but they work in very different ways.

Let’s break down the key differences in costs, coverage, enrollment rules, and provider networks so you can make the best choice for your needs.

1. Costs: Monthly Premiums vs. Out-of-Pocket Costs

Medicare Advantage (Part C)

• Often has low or $0 monthly premiums beyond your Medicare Part B premium.
• You pay as you go with copays and coinsurance for doctor visits, hospital stays, and medications.
• There’s a yearly out-of-pocket maximum (e.g., around $8,300 in 2024 for in-network care). Once you hit this limit, the plan covers 100% of approved costs.
• Costs can be unpredictable if you need frequent care.

Medicare Supplement (Medigap)

• You pay a separate monthly premium (ranges from $30 to $400+ per month depending on the plan).
• Covers most or all of Medicare’s deductibles, copays, and coinsurance, reducing your out-of-pocket expenses.
• No out-of-pocket maximum, but since most costs are covered, your expenses remain very predictable.

Key Takeaway: If you prefer lower monthly premiums and are okay with paying costs as you need care, Medicare Advantage might be a better fit. If you want predictable healthcare costs with fewer unexpected bills, Medigap could be the better choice.

2. Coverage: Extra Benefits vs. Cost Protection

Medicare Advantage (Part C)

• Covers everything Original Medicare does and usually includes prescription drug coverage (Part D).
• Often bundles in extra benefits like dental, vision, hearing, and wellness programs.
• Services and benefits vary by plan, and some services may have coverage limits.

Medicare Supplement (Medigap)

• Does not expand Medicare’s coverage but helps pay for Medicare-approved expenses like deductibles and copays.
• Does not include dental, vision, hearing, or prescription drugs—you must buy a separate Part D plan for medications.
• Some plans cover foreign travel emergency care (Original Medicare alone does not).

Key Takeaway: If extra benefits like dental and vision are important, Medicare Advantage might be the way to go. If you want stronger cost protection with fewer out-of-pocket expenses, Medigap is a better fit.

3. Enrollment Rules: When and How You Can Sign Up

Medicare Advantage

• You must have Medicare Parts A & B and live in the plan’s service area.
• You can switch or enroll during:
  • Initial Enrollment Period (IEP): Around your 65th birthday.
  • Annual Election Period (AEP): October 15 – December 7 each year.
  • Medicare Advantage Open Enrollment Period: January 1 – March 31 (if you already have an MA plan).
• No medical underwriting – you cannot be denied coverage based on health conditions.

Medicare Supplement (Medigap)

• You must have Original Medicare (Parts A & B) (you cannot have a Medicare Advantage plan at the same time).
• The best time to enroll is during your Medigap Open Enrollment Period (a 6-month window that starts when you turn 65 and have Medicare Part B).
• After this period, insurers can deny you coverage or charge higher premiums based on pre-existing conditions.
• No annual open enrollment – changing plans later can be difficult.

Key Takeaway: Medicare Advantage has more flexible enrollment periods and does not require health underwriting. Medigap offers the best deal if you sign up when you’re first eligible, but you may face restrictions or higher costs if you apply later.

4. Provider Networks: Freedom of Choice vs. Managed Care

Medicare Advantage (Part C)

• Most plans have provider networks (HMO, PPO), meaning you may have to use in-network doctors and hospitals to get full benefits.
• Out-of-network care may not be covered or will cost more (unless it’s an emergency).
• May require referrals and prior authorizations for certain services.
• Coverage is regional – if you travel, your plan might not cover care outside the service area.

Medicare Supplement (Medigap)

• No networks – see any doctor or specialist in the U.S. who accepts Medicare!
• No referrals required – you can see any specialist who takes Medicare.
• Provides nationwide coverage – great for people who travel.
• Some plans cover emergency care abroad.

Key Takeaway: If provider flexibility is a priority, Medigap is the clear winner. If you’re comfortable using a specific network and want the convenience of bundled coverage, Medicare Advantage may work better.

Which Plan Is Right for You?

Final Thoughts

Choosing between Medicare Advantage and Medigap depends on what matters most to you:

✔️ Want lower monthly premiums and extra benefits like dental & vision? → Medicare Advantage might be a good fit.

✔️ Want predictable costs, freedom to see any doctor, and stronger financial protection? → Medicare Supplement (Medigap) may be better.

Need help choosing? We’re here to guide you through your options! Contact us today to find the plan that best fits your needs.

If you have questions or need assistance finding a health plan, call one
of our Licensed Agents at
Trusted Senior Specialists. There is no cost or obligation for a consultation! 

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