Medicare Advantage vs. Medigap: Things to Know

Medicare can be a relatively complicated health insurance program; it’s important to consider plans that align as closely as possible with an individual’s specific needs. While this level of personalization is great, this also means that shopping for Medicare often requires up-front research, including knowing the different plan types available to you, and how each plan type compares to one another.

In this article, we’ll do an in-depth comparison of two plan types: Medicare Advantage vs. Medigap. We’ll go through what each plan covers, advantages and disadvantages, and the different features between the two.

Medicare Advantage & Medigap: What are They & Who Benefits From Them? The first step that needs to be done before jumping in and making a decision is understanding what each plan actually is:

What Is Medicare Advantage? Medicare Advantage (also known as Medicare Part C ) is a plan alternative to Original Medicare (Parts A and B), and is sold by private companies. It offers coverage that extends beyond typical Medicare plans, often including additional benefits.

Who Is Medicare Advantage For? Medicare Advantage is a great plan for those who are:

Generally Healthy : If you don’t see specialists often, and are not affected by any chronic conditions, Medicare Advantage could be right for you. Looking for Non-Medical Perks : Medicare Advantage may offer fitness and wellness benefits like gym memberships. Receiving Care Locally : Medicare Advantage is based on regional provider networks, making it a great choice for those who don’t travel often. Wanting Care Coordination : Those enrolled in Medicare Advantage are required to have a primary care physician (PCP) to manage follow-ups, referrals, and prescriptions. Need Predictable Costs : Many Medicare Advantage plans typically offer lower premiums and annual out-of-pocket maximums. One word of caution: be sure to use a plan comparison tool like Healthpilot so that you won’t be affected by any of the hidden costs of Medicare Advantage. What Is Medigap? Medigap (also known as Medicare Supplement Insurance ) is meant to serve as a supplement to Original Medicare (Parts A and B), and is sold by private companies rather than by Medicare.gov .

Who Is Medigap For? Medigap can be a great choice for individuals who:

Are Already Enrolled in Medicare Parts A & B : Since Medigap is a supplement to Original Medicare, you must already be enrolled in Original Medicare to enroll in Medigap. Require Additional Coverage : Medigap offers supplemental coverage for expenses that may not be covered by Medicare Parts A & B, such as deductibles, coinsurance, and copays. Plan on Travelling Internationally : Some Medigap plans may cover emergency care outside of the U.S., something that is not covered by Original Medicare. Don’t Need Additional Coverage : Medigap plans typically do not include the same additional benefits as Medicare Advantage plans. What Are the Pros & Cons of Medicare Advantage & Medigap? Though both Medicare Advantage and Medigap are Medicare plan options that are sold by private companies, they function differently and cover different things.

Let’s dive into the pros and cons of each.

Medicare Advantage vs. Medigap: Pros & Cons As you explore both plans, let’s run through the pros and cons of Medicare Advantage vs. Medigap:

Pros of Medicare Advantage Medicare Advantage typically offers lower monthly premiums , leading to consistent monthly payments. This can be appealing for those looking for predictable healthcare costs. Rather than building your Medicare plan part by part, Medicare Advantage offers an all-in-one solution that even includes prescription drugs. Non-medical benefits extend the coverage of Medicare Advantage even further. Cons of Medicare Advantage Due to Medicare Advantage’s HMO and PPO network structures, the doctors you will be able to see will likely be limited to your local area . If you don’t plan on traveling to receive care, this may not be as big of an issue for you. Medicare Advantage HMO plans are based on care coordination with a prior authorization system , meaning you need to be referred to specialists by your primary care physician with a prior authorization from the plan administrator. This can delay care or slow down the process. Individual Medicare Advantage plan providers can set their own out-of-pocket maximums . Though these costs are capped legally, they can still be high , particularly when out-of-network care is required. Pros of Medigap Because Medigap is a supplement to Original Medicare, it achieves its purpose of helping pay for most out-of-pocket expenses . Unlike Medicare Advantage, Medigap does not rely on a regional network structure, meaning that enrollees have nationwide provider access . Those who enroll in Medigap may enjoy certain perks, like plans that cover international emergency care coverage . Medigap plans offer a fixed monthly premium , which also helps with cost predictability. Cons of Medigap When it comes to monthly premiums , the other side of the coin is this: though these expenses are predictable, they will be typically higher than those associated with Medicare Advantage. Unlike some Medicare Advantage plans, Medigap plans do not include drug coverage; Medicare Part D must be added for those looking to enroll in a prescription drug plan. If you miss your Medigap Open Enrollment Period, insurance companies can require medical underwriting . The open enrollment period for Medigap begins on the first day of your Medicare Part B coverage when you are 65 or older, and lasts for six months from that date.

Is It Better to Have Medicare Advantage or Medigap? Your Medicare coverage is built around your unique needs, meaning that every individual will have their own version of what the “best” plan for them is.

A great way to understand whether Medicare Advantage or Medigap is right for you is by using a guided platform like Healthpilot , which not only compares plans, but also helps you find the best fit based on your unique needs.

We use the information you give us to give you an easy way to compare plans, and even provide recommendations to help you enroll in your best fit plan. You can even sign up for the plan that you choose directly from our website; and the benefits don't stop there. After enrollment, Healthpilot continues to serve as your dedicated Medicare support advisor:

Executing yearly plan reviews to see whether your Medicare plan is continuing to meet your needs. Acting as a liaison between you and your Medicare plan insurance carrier ensure appeals are filed with the right department, ID cards are delivered, and address changes are reflected. Being available to answer your Medicare benefit questions Monday-Friday between the hours of 9am and 6pm CST. Medicare Advantage vs. Medigap FAQs Can I switch between Medicare Advantage and Medigap? The short answer is yes, but it’s not always easy.

You can switch during certain enrollment periods, but if you're outside of your Medigap Open Enrollment Period, insurers may require medical underwriting, could deny coverage, or simply charge more based on your health.

Can I have both Medicare Advantage and Medigap? No, you cannot be enrolled in both Medicare Advantage and Medigap simultaneously.

Medigap plans are designed to work with Original Medicare (Parts A and B), not Medicare Advantage.

When can I enroll or switch between Medicare Advantage and Medigap, or vice versa? To enroll in Medicare Advantage or Medigap, or switch between these two plans, keep these enrollment periods in mind:

Initial Enrollment Period (IEP) : During this window, you can enroll in Medicare Advantage or Medigap as part of your initial enrollment into Medicare. This seven-month window begins three months before the month you turn 65 and ends three months after. Medicare Advantage Open Enrollment Period (MA OEP) : This period runs from January 1-March 31, and applies to those already enrolled in Medicare Advantage. During this period, you can switch to a different Medicare Advantage plan or return to Original Medicare. If you switch back to Original Medicare, you may also be able to apply for a Medigap policy, but keep in mind that acceptance isn’t guaranteed and medical underwriting may be necessary. Annual Enrollment Period (AEP) : This period runs from October 15-December 7. During this period, you can switch from Original Medicare to Medicare Advantage, or vice versa. Similar to the note on MA OEP, keep in mind that Medigap policies may involve medical underwriting unless you also happen to fall within your Medigap Open Enrollment Period or state specific guarantee issue rights. Medigap Open Enrollment Period : This period is a six-month window that begins when you are both over 65+ years of age and enrolled in Medicare Part B. During this period, you will have the option to buy any Medigap plan sold in your state with guaranteed acceptance. For more concrete information or to understand your eligibility on a personal level, speak with one of our licensed Medicare brokers or use an online comparison tool like Healthpilot's .

Are there any penalties for switching between Medicare Advantage and Medigap? Although there aren't financial penalties for switching between Medicare Advantage and Medigap, there can be consequences depending on when and how you make the switch.

If you're in your Medigap Open Enrollment Period (a six-month window starting when you first enroll in Part B), or if you qualify for a Medigap trial right, you can switch without medical underwriting. Switching from Medigap to Medicare Advantage is usually easier, and you can do it during certain enrollment periods without penalties. But you may not be able to switch back to Medigap later without going through underwriting. To summarize, there are no direct penalties, but timing and eligibility rules matter. If you’re unsure about your unique situation, feel free to reach out to Healthpilot’s Medicare advisors.

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