Two different ways to receive Medicare coverage
Medigap and Medicare Advantage serve different roles. Medigap supplements Original Medicare; Medicare Advantage is a private insurer’s alternative way to receive Medicare benefits. Your doctors, prescriptions, budget, travel, and enrollment rights should guide the comparison.
You cannot use Medigap to pay a Medicare Advantage plan’s copayments, deductibles, or premiums.
How Original Medicare with Medigap works
With Original Medicare, you keep Part A and Part B. A Medigap policy helps pay certain remaining costs for covered medical services, depending on the plan letter. You generally can use doctors and hospitals nationwide that accept Medicare. Medicare SELECT policies are an exception with network requirements.
New Medigap policies do not include prescription drug coverage, so many people add a separate Part D plan. You pay the applicable Part B, Medigap, and drug-plan premiums. Medigap premiums can increase, and your remaining costs depend on the policy and the care you receive. It does not make every service Medicare excludes a covered service.
How Medicare Advantage works
Medicare Advantage provides Part A and Part B benefits through a Medicare-approved private plan. You must have both parts and generally continue paying the Part B premium. Most plans include Part D; some include dental, vision, hearing, or fitness benefits. A $0 plan premium does not mean $0 health care.
HMOs generally require network providers for routine care, with specified exceptions. PPOs generally allow covered out-of-network care at a higher cost, but an out-of-network provider may decline to treat you. Referrals and prior authorization vary by plan. Confirm your exact plan with both the provider and insurer.
Compare an ordinary year and a year with more care
Add premiums to expected medical and prescription costs. For Medicare Advantage, review the limit for covered Part A and Part B services, including any separate network limits. Premiums and Part D drug costs do not count toward that medical limit.
Original Medicare alone has no annual out-of-pocket limit. Medigap helps pay covered cost sharing according to the policy, but premiums, prescriptions, and non-covered services still need a budget. Recheck drug coverage annually even if you keep the same Medigap policy.
Check your right to buy Medigap before switching
Your federal Medigap Open Enrollment Period lasts six months, beginning the first month you are both 65 or older and enrolled in Part B. After that window, medical underwriting may apply unless you qualify for a guaranteed issue right or state protection.
Fall Annual Enrollment does not automatically guarantee acceptance into Medigap. Before leaving Medicare Advantage, confirm Medigap eligibility, drug coverage, and effective dates. Do not cancel existing coverage until the replacement and timing are confirmed.
Review the options around your life
Have your doctors, prescriptions, pharmacies, current plan, travel needs, and budget ready. We can help you understand the differences and the options we offer before you decide.
Sonon Insurance can explain and compare the options we are licensed and appointed to offer. We do not offer every plan available in your area. Any information we provide is limited to those plans we offer. Please contact Medicare.gov, 1-800-MEDICARE (1-800-633-4227), or your local State Health Insurance Assistance Program to get information on all of your options. Sonon Insurance is not affiliated with or endorsed by Medicare or the federal government.
Compare your two coverage paths
Use these differences alongside the actual plan documents and your eligibility. On a small screen, scroll the table to see both paths.
| What to compare | Original Medicare with Medigap and Part D | Medicare Advantage |
|---|---|---|
| Providers | Generally providers nationwide that accept Medicare; SELECT policies have network rules | Networks vary; PPOs generally allow covered out-of-network care at higher cost |
| Premiums | Part B plus separate Medigap and Part D premiums; premiums can change | Part B plus any plan premium; some plans have a $0 plan premium |
| Medical costs | Medigap pays covered cost sharing according to its plan letter | Plan-specific deductibles, copays, and coinsurance; annual medical spending limit |
| Prescriptions | Usually a separate Part D plan; new Medigap policies do not include drugs | Most plans include Part D; check exact medications and pharmacies |
| Care rules | Usually no specialist referral requirement | Referrals and prior authorization may apply |
| Changing later | Medical underwriting may apply outside protected enrollment opportunities | Changes require an applicable enrollment period; plan terms can change annually |
Helpful resources
Coverage, eligibility, and plan terms vary by carrier and state. This article is general information, not a promise of coverage or individualized financial advice.
