What is the difference between Medicare Advantage and Medigap?
They solve the same problem in opposite ways, and you can only have one. Here is how to tell which fits your situation.
Both exist to solve one problem: Original Medicare covers about 80 percent of most services and puts no ceiling on your share of the rest. Advantage and Medigap fix that in opposite ways.
You cannot hold both. It is one or the other.
Medigap replaces your share
You keep Original Medicare. The supplement pays the deductibles and coinsurance Medicare leaves behind. You add a standalone Part D plan for prescriptions.
- Any provider nationwide that accepts Medicare
- No networks, no referrals, minimal prior authorization
- Very predictable. With a comprehensive plan you rarely see a bill
- Higher fixed monthly cost: supplement premium plus drug plan premium
- No dental, vision or hearing
Advantage replaces the delivery
A private plan administers your Medicare, usually including drugs and extra benefits.
- Often no premium beyond Part B
- Drugs, dental, vision and hearing commonly bundled
- An annual out of pocket maximum
- Network based, with referrals and prior authorization
- Costs arrive as copays, which vary with how much care you use
The honest way to compare cost
Do not compare premiums. Compare two totals.
- Medigap path: twelve months of supplement premium plus twelve months of drug plan premium, plus the Part B deductible. That is close to your worst case and your best case at once, because it barely moves with usage.
- Advantage path: twelve months of any plan premium plus the plan's annual out of pocket maximum. That is your worst case. Your best case in a healthy year is close to zero.
Now ask which risk you would rather carry. Advantage is cheaper in a good year and can be more expensive in a bad one. Medigap costs the same either way.
The underwriting clock
This is what makes the decision less reversible than it looks.
For six months after your Part B starts, you can buy any Medigap policy in Texas with no health questions. After that window closes, Texas insurers can underwrite you and decline.
Advantage to Medigap later is the move that may not be available. Medigap to Advantage is almost always available. If you are genuinely torn, that asymmetry is a real argument for starting on the supplement side while the door is open.
Which tends to fit whom
Medigap tends to fit people who travel or live part of the year elsewhere, have a chronic condition needing specialists, want a specific doctor or hospital regardless of network, or simply want no surprises.
Advantage tends to fit people whose doctors are already local and in network, who want dental and vision included, who are healthy and would rather not pay a premium every month, and who are comfortable with referrals and authorizations.
In Hidalgo County the networks are deep and most people are on Advantage plans, which is a legitimate reason it works well here. It is still worth checking your own doctors rather than assuming. See how to verify your doctors.
Common follow-up questions
Can I have both a Medigap policy and an Advantage plan?
No. It is not allowed, and paying for both would be wasted money since the supplement cannot pay anything while you are in an Advantage plan.
Which is cheaper?
Advantage is almost always cheaper month to month. Medigap is often cheaper across a year with major medical costs. It depends on your health, not on the plans.
Can I try Advantage and switch to Medigap if I do not like it?
Sometimes. There is a trial right in specific circumstances, mainly if you joined an Advantage plan when you first turned 65 and drop it within twelve months. Outside those rules you may face underwriting.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
Call (956) 687-3334Read next
What is Medicare Advantage (Part C)?
Medicare Advantage