Once you have Medicare Part A and Part B, you will face an important question: should you choose a Medicare Advantage plan, or stay with Original Medicare and add a Medicare Supplement (Medigap) policy? Both approaches can work well. The right choice depends on how you use care, where you live and what you value most.

How Each Option Works

Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers approved by Medicare. They provide your Part A and Part B benefits and often include prescription drug coverage and extra benefits such as routine dental, vision, hearing or fitness programs. Most plans use a network of doctors and hospitals, commonly as an HMO or PPO.

Medicare Supplement (Medigap)

Medigap policies work alongside Original Medicare. Medicare pays its share of approved costs first, then your Medigap policy helps pay some or all of the remaining deductibles, copayments and coinsurance, depending on the plan. Medigap plans are standardized by letter in most states, so a given plan letter offers the same basic benefits no matter which company sells it. Medigap does not include drug coverage, so most people also enroll in a Part D plan.

Key Differences to Consider

Monthly premiums

Many Medicare Advantage plans have relatively low monthly premiums, and some areas offer plans with no additional premium beyond Part B. Medigap policies usually have a higher monthly premium, plus the cost of a separate Part D plan.

Costs when you receive care

With Medicare Advantage, you typically pay copays or coinsurance as you use services, up to the plan's annual out-of-pocket maximum. With Medigap, many out-of-pocket costs are covered by the policy, so costs at the time of care are often lower and more predictable.

Choice of doctors

Original Medicare with Medigap generally lets you see any provider in the country that accepts Medicare, without referrals. Medicare Advantage plans usually have networks, and going out of network may cost more or may not be covered except in emergencies.

Prior authorization and referrals

Medicare Advantage plans may require prior authorization for certain services and referrals to see specialists. Original Medicare generally uses these requirements far less often.

Extra benefits

Medicare Advantage plans frequently include benefits Original Medicare does not cover, such as routine dental or vision care. With Medigap, you would typically purchase those coverages separately if you want them.

Travel

If you spend part of the year in another state, Original Medicare with Medigap may offer more flexibility. Some Medicare Advantage plans offer travel or visitor benefits, but coverage outside the service area is often limited.

Switching Later Is Not Always Simple

You can move from Medicare Advantage back to Original Medicare during certain enrollment periods. However, buying a Medigap policy after your initial Medigap Open Enrollment Period may involve health questions in many states, and you could be declined or charged more. This is one reason the first decision deserves careful thought.

Questions to Ask Yourself

  • Are my current doctors and hospitals in the plan's network?
  • Would I prefer lower premiums or more predictable costs when I get care?
  • How often do I expect to see specialists?
  • Do I travel frequently or live in more than one state?
  • Are my prescriptions covered, and at what cost?
  • Do I want extra benefits like dental or vision included?

The Bottom Line

There is no universally better choice. Medicare Advantage can appeal to people who want lower premiums and bundled benefits and are comfortable with a network. Medigap can appeal to people who want broad provider access and predictable costs. Comparing specific plans in your area, with your doctors and medications in mind, is the best way to decide.

This article is general information and is not a recommendation of any specific plan. Benefits, costs and availability vary by plan and location.