Medicare Advantage vs. Medigap: How Do You Choose?
One of your most important Medicare decisions is how you want to receive your coverage. Two common approaches are Medicare Advantage and Original Medicare paired with Medicare Supplement insurance, also known as Medigap.
Neither option is automatically best for everyone. Your best fit depends on your healthcare needs, doctors, prescriptions, travel habits and budget.
How Medicare Advantage works
Medicare Advantage plans are offered by private insurance companies approved by Medicare. They provide your Part A and Part B benefits through the plan. Most include prescription coverage, and many include additional dental, vision, hearing or fitness benefits.
Depending on the plan, you may need to use a provider network or follow prior-authorization and referral requirements.
Potential advantages include:
Low or zero additional plan premiums
Medical and prescription benefits combined
An annual limit on covered medical out-of-pocket expenses
Additional dental, vision or hearing benefits
Important considerations include:
Provider networks
Copays and coinsurance
Prior authorization
Prescription formularies
Coverage while traveling
How Medigap works
With Medigap, Original Medicare remains your primary insurance. A standardized Medigap policy helps pay certain deductibles, copays and coinsurance left by Original Medicare. You generally purchase a separate Part D plan for prescriptions.
Potential advantages include:
Broad access to providers that accept Medicare
More predictable medical expenses, depending on the policy
No provider network for Medicare-covered services
Greater flexibility for domestic travel
Important considerations include:
A separate monthly Medigap premium
A separate Part D plan is normally needed
Routine dental, vision and hearing benefits generally are not included
Medical underwriting may apply if you try to purchase Medigap later
Medicare Advantage is an alternative way to receive Medicare benefits, while Medigap supplements Original Medicare. You cannot use both simultaneously.
Can you switch from Medicare Advantage to Medigap?
Medicare Open Enrollment may allow you to leave Medicare Advantage and return to Original Medicare. However, that does not automatically guarantee acceptance into a Medigap policy.
Outside your Medigap Open Enrollment Period or another guaranteed-issue situation, an insurer may use medical underwriting where permitted. Confirm your Medigap eligibility before leaving existing coverage.
Questions to consider
Are my doctors and hospitals accessible?
Are my prescriptions covered affordably?
Do I prefer lower premiums or more predictable expenses?
How frequently do I travel?
Am I comfortable using a provider network?
Could qualifying for Medigap become difficult later?
Friendliest Agent is here to help you compare the complete picture—not simply one premium or extra benefit. Email or call us today and we would be happy to help you through the process!
This article is for general educational purposes. Availability, underwriting, benefits, networks, formularies and costs vary. Friendliest Agent is not connected with or endorsed by the U.S. government or the federal Medicare program.
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