Medigap and Medicare Advantage are the two main plan options available to you when you become eligible for Medicare. Depending on your situation and healthcare preferences, one plan is likely going to provide you with more value.

We’re going to compare Medigap vs Medicare Advantage this way you can make the most informed decision when it comes to your health care.

What’s the Difference, Medigap vs Medicare Advantage?

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

If you want coverage that gives you the most flexibility, a Medigap plan could be your ideal policy.

Medigap Doctor Network

When you have a Medicare Supplement, you can go to any doctor in the United States that accepts Medicare. This type of policy is especially beneficial for people that travel or people that 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.

Medigap 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 as well as 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

Top Medicare Advantage plans have been called Medicare replacement plans, though the term isn’t considered correct. But these plans take over your health coverage and Medicare is no longer responsible for the approval of 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 every time you go to a doctor, hospital, or have any 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.

Which Plan Requires Referrals Medigap or Medicare Advantage?

Medigap plans don’t require a referral, you can go to any doctor or specialist that accepts Medicare at any time. Medicare Advantage plans, especially the HMO plan options require referrals.

If you’re someone that doesn’t want to pay to see the primary care doctor just to pay to see the specialist,

What is Better Medigap or Medicare Advantage?

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

The Benefit of a Medicare Supplement

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

If you have serious medical conditions or serious medical conditions run in your family, a Medigap plan could be a huge money saver. It’s better to have the insurance coverage you need before you need it.

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

With Medigap insurance, you can enroll or change your plan any time of the year, 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 Benefit 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 you decide which option to choose, make sure 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.

Which is Cheaper Medicare Advantage or Medigap?

It’s hard to determine exactly which is cheaper Medigap or Part C. Since costs and coverage on these two plans are apples to oranges, it’s going to depend on what you anticipate your health care costing. Another factor is whether you want to have financial risk exposure or risk protection.

Medigap vs Part C Premium

When it comes to premiums, Medigap is rightfully more expensive. Part C premiums are as low as $0, and 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 really 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, eligibility, the plan you choose, and other factors.

Medicare Supplement vs Part C 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 of 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 that means you only pay $3,600 for the year no matter how serious your health conditions become. If you have a Part C plan you could pay $11,000 in health care costs.

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 is going to provide value.

Can I Switch from Medicare Advantage to Medigap?

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

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.”

There are other instances where 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 that becomes effective January 1st of the following year. If your Medigap plan is approved, your Medicare Advantage plan will need to be canceled, you can’t have both plans at the same time.

Can I Switch from Medigap to Medicare Advantage?

You can change from a Medigap plan to a Medicare Advantage plan but getting back on Medigap could be a challenge. Before you change, make sure the switch is in your best interest long term.

How to Choose Between Medigap 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 provide them with the most value and other people 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 give us a call at the number above. If you prefer to compare your options online, fill out an online rate form now.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert 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.