Understanding the Difference Between Medigap and Medicare Advantage

Medigap and Medicare Advantage are two popular options for seniors to supplement their Original Medicare coverage. Medigap, also known as Medicare Supplement Insurance, is designed to fill the gaps in Original Medicare, covering costs like deductibles and copays.

Medicare Advantage, on the other hand, is an alternative to Original Medicare, offered by private insurance companies. It's a more comprehensive plan that includes additional benefits like vision, dental, and hearing coverage.

The key difference between Medigap and Medicare Advantage is that Medigap only supplements Original Medicare, while Medicare Advantage replaces it. This means that if you enroll in a Medicare Advantage plan, you'll no longer have Original Medicare coverage.

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You can choose between original Medicare, supplemented with a private Medigap policy, or a private insurer through a Medicare Advantage plan.

Original Medicare allows you to use any doctor and facility that accepts Medicare, but you'll need to buy separate Medigap and Part D drug coverage to fill in the gaps.

With Medicare Advantage, you may have low or no premiums beyond your monthly Part B premiums, but you'll typically need to use a provider network and may have more prior authorization requirements.

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Medicare is a federal health insurance program primarily for people 65 or older, but also for certain younger people with disabilities and those with End-Stage Renal Disease (ESRD).

It was established in 1965 as part of President Lyndon B. Johnson's Great Society program, with the goal of providing health coverage to seniors and low-income individuals.

Medicare has four main parts: Part A, Part B, Part C, and Part D.

Part A covers hospital stays, skilled nursing facility care, and some home health care services.

For another approach, see: Medicare Part C vs Medigap

You can see any doctor or hospital that accepts Medicare with Original Medicare.

Traveling can be a challenge with Medicare Advantage plans, which often have limited service areas. If you travel outside your area, you may have to pay out of pocket for medical care.

If you have a chronic condition or receive frequent medical care, Original Medicare with a Medigap plan can save you money. The out-of-pocket maximum for in-network care on a Medicare Advantage plan can be as high as $9,350 in 2025.

In the worst-case scenario, if you're diagnosed with a serious condition later in life, you may want to get care from the best specialists. These specialists may or may not take your Medicare Advantage plan.

Here are some key benefits of Original Medicare with a Medigap plan:

Medicare Advantage plans come with limited service areas, which can be a problem if you travel. On the other hand, Original Medicare with a Medigap plan gives you access to any doctor or hospital that accepts Medicare, no matter where you are in the country.

If you have a chronic condition or see a lot of doctors, a Medigap plan may be a better choice. This is because Medigap plans cover many out-of-pocket costs, which can add up quickly on Medicare Advantage plans.

Here are some key differences between Medigap and Medicare Advantage plans:

Ultimately, the choice between a Medigap and Medicare Advantage plan depends on your individual needs and circumstances. If you want the freedom to see any doctor or hospital that accepts Medicare, a Medigap plan may be the way to go.

Insurance is a type of financial protection that helps cover unexpected medical costs.

It's designed to bridge the gap between what your healthcare provider charges and what your healthcare plan pays.

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Medicare Advantage and Medigap plans have some key differences that can impact your healthcare costs and coverage. Medicare Advantage plans often have a provider network, which means your costs are lower when you visit in-network doctors and hospitals. Some Medicare Advantage plans may also charge more or not cover doctors or facilities outside of a plan's network.

Medicare Advantage plans usually have a low or no premium beyond your monthly Part B premiums, but out-of-pocket expenses will likely be different depending on the services you use. With Medigap, you can choose any doctor and hospital that accepts Medicare, but you'll have to buy separate Medigap and Part D drug coverage to fill in the gaps.

Medicare Advantage plans have a cap on out-of-pocket costs, which is $8,850 or less for in-network health services, and $13,300 or less for covered in-network and out-of-network services combined. Medigap plans, on the other hand, do not have a cap on out-of-pocket costs, but they can cover many out-of-pocket expenses.

Here are the main differences between Medicare Advantage and Medigap plans:

Medicare Advantage plans often include extra benefits like routine dental, vision, and hearing services, which can be a major advantage for those who need these services. Medigap plans, on the other hand, do not include these extra benefits, but you can buy separate coverage for them.

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Medigap plans are standardized, meaning they must offer the same benefits, regardless of the insurance company.

There are 10 standardized Medigap plans, labeled A through N, with Plan F offering the most comprehensive coverage.

Medicare Advantage plans, on the other hand, are offered by private insurance companies and can have varying levels of coverage.

To choose the right Medigap plan, consider your healthcare needs and budget.

Plan F, for example, covers 100% of Medicare Part B deductibles, but it's also the most expensive option.

Medicare Advantage plans often come with a network of healthcare providers, which can limit your choices.

If you travel frequently, a Medigap plan may be a better option, as it allows you to see any doctor, anywhere.

Medicare Advantage plans may also have out-of-pocket limits, but the specifics vary by plan.

Medicare Advantage premiums, deductibles, and other costs can vary by plan and change each year.

You'll need to pay the Part B premium, which is $185 in 2025, to stay in your plan.

The out-of-pocket limit can also vary by plan, but once you reach it, the plan pays 100% of your covered health services for the rest of the year.

Medicare Advantage premiums can vary by plan and change each year. You must pay the Part B premium, which is $185 in 2025, to stay in your plan. The out-of-pocket limit can also vary by plan, but once you reach it, the plan pays 100% of your covered health services for the rest of the year.

You can buy a Medigap policy at any time you have Medicare Part A and Part B. However, Medigap insurers in most states can reject you or charge more if you have preexisting conditions unless you buy a policy during certain times.

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If you're 65 or older, you can buy a policy within six months of enrolling in Medicare Part B without preexisting condition concerns. This is a great time to shop around and find the best policy for you.

Some states have extra protections for Medigap policy buyers. Contact your State Health Insurance Assistance Program (SHIP) to find out more about your state's rules.

Medicare Advantage plans, also known as Medicare Part C, are an all-in-one alternative to original Medicare. You can explore these plans through the Medicare Plan Finder or from your state insurance department.

You can find out more about Medigap plans in your area by visiting the Medicare Plan Finder or contacting your state insurance department.

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You can switch from a Medicare Supplement plan to a Medicare Advantage plan, but only during the Medicare Open Enrollment Period, which runs from Oct. 15 to Dec. 7 each year.

To make this switch, you'll need to contact your Medigap insurance company to cancel your current plan before enrolling in a Medicare Advantage plan.

If you're interested in routine dental, vision, hearing, or prescription drug benefits, switching to a Medicare Advantage plan might be a good option for you.

You can change from a Medicare Advantage plan to a Medicare Supplement plan during the Annual Enrollment Period, which also runs from Oct. 15 to Dec. 7 each year.

It's worth noting that one type of plan is not inherently better than the other - they just offer different types of coverage, so finding the right fit for you depends on your specific needs.