MEDICARE SUPPLEMENT VS ADVANTAGE PLAN

Feature Medicare Supplement (Medigap) Medicare Advantage (Part C)
COVERAGE BASICS
What It Is Supplemental insurance that works WITH Original Medicare Replacement plan that takes over for Original Medicare
Provider Network No network restrictions - see any doctor/hospital that accepts Medicare nationwide Must use plan's network (HMO/PPO); limited to specific providers
Referrals Required No referrals needed Often requires referrals to see specialists
Prior Authorization Not required Often required for certain services and procedures
COSTS
Monthly Premium Higher ($150-$400+) depending on plan and location Lower (often $0-$100) beyond Part B premium
Out-of-Pocket Costs Minimal copays/coinsurance after premium Copays for each service ($10-$50 doctor, $100-$400/day hospital)
Annual Out-of-Pocket Max None (but coverage is comprehensive) Yes (capped at $8,850 for 2025)
Cost Predictability Highly predictable - you know monthly costs upfront Less predictable - varies based on healthcare usage
BENEFITS & COVERAGE
Prescription Drug Coverage NOT included - must purchase separate Part D plan Often included in the plan
Extra Benefits None - only covers Medicare gaps Often includes dental, vision, hearing, fitness, OTC allowances
Plan Standardization Standardized (Plans A-N same nationwide) Varies widely by insurer and region
TRAVEL & FLEXIBILITY
Travel Coverage Excellent - works nationwide, many plans cover foreign emergency care Limited to plan's service area; emergency care only outside network
Ideal for Travelers Yes - full flexibility anywhere in the U.S. No - geographically restricted
ENROLLMENT & CHANGES
Enrollment Flexibility Difficult to change after initial enrollment (medical underwriting) Can switch plans annually during open enrollment (no underwriting)
Best Initial Enrollment Age 65 or first Medicare enrollment (guaranteed issue) Can enroll anytime during eligibility
Medical Underwriting Yes, after guaranteed issue period No underwriting needed
Switching Plans Difficult to get Medigap after choosing Advantage Can switch to Advantage anytime during enrollment periods
Paperwork/Claims Minimal - Medicare and Medigap handle automatically Plan manages all claims
BOTTOM LINE
Choose This If... You want comprehensive coverage, complete provider choice, predictable costs, travel flexibility, and can afford higher premiums You want lower monthly costs, don't mind network restrictions, value extra benefits like dental/vision, stay in one area, and prefer an out-of-pocket maximum
COVERAGE BASICS
What It Is
Medicare Supplement (Medigap)
Supplemental insurance that works WITH Original Medicare
Medicare Advantage (Part C)
Replacement plan that takes over for Original Medicare
Provider Network
Medicare Supplement
No network restrictions - see any doctor/hospital that accepts Medicare nationwide
Medicare Advantage
Must use plan's network (HMO/PPO); limited to specific providers
Referrals Required
Medicare Supplement
No referrals needed
Medicare Advantage
Often requires referrals to see specialists
Prior Authorization
Medicare Supplement
Not required
Medicare Advantage
Often required for certain services and procedures
COSTS
Monthly Premium
Medicare Supplement
Higher ($150-$400+) depending on plan and location
Medicare Advantage
Lower (often $0-$100) beyond Part B premium
Out-of-Pocket Costs
Medicare Supplement
Minimal copays/coinsurance after premium
Medicare Advantage
Copays for each service ($10-$50 doctor, $100-$400/day hospital)
Annual Out-of-Pocket Max
Medicare Supplement
None (but coverage is comprehensive)
Medicare Advantage
Yes (capped at $8,850 for 2025)
Cost Predictability
Medicare Supplement
Highly predictable - you know monthly costs upfront
Medicare Advantage
Less predictable - varies based on healthcare usage
BENEFITS & COVERAGE
Prescription Drug Coverage
Medicare Supplement
NOT included - must purchase separate Part D plan
Medicare Advantage
Often included in the plan
Extra Benefits
Medicare Supplement
None - only covers Medicare gaps
Medicare Advantage
Often includes dental, vision, hearing, fitness, OTC allowances
Plan Standardization
Medicare Supplement
Standardized (Plans A-N same nationwide)
Medicare Advantage
Varies widely by insurer and region
TRAVEL & FLEXIBILITY
Travel Coverage
Medicare Supplement
Excellent - works nationwide, many plans cover foreign emergency care
Medicare Advantage
Limited to plan's service area; emergency care only outside network
Ideal for Travelers
Medicare Supplement
Yes - full flexibility anywhere in the U.S.
Medicare Advantage
No - geographically restricted
ENROLLMENT & CHANGES
Enrollment Flexibility
Medicare Supplement
Difficult to change after initial enrollment (medical underwriting)
Medicare Advantage
Can switch plans annually during open enrollment (no underwriting)
Best Initial Enrollment
Medicare Supplement
Age 65 or first Medicare enrollment (guaranteed issue)
Medicare Advantage
Can enroll anytime during eligibility
Medical Underwriting
Medicare Supplement
Yes, after guaranteed issue period
Medicare Advantage
No underwriting needed
Switching Plans
Medicare Supplement
Difficult to get Medigap after choosing Advantage
Medicare Advantage
Can switch to Advantage anytime during enrollment periods
Paperwork/Claims
Medicare Supplement
Minimal - Medicare and Medigap handle automatically
Medicare Advantage
Plan manages all claims
BOTTOM LINE - CHOOSE THIS IF...
Medicare Supplement
You want comprehensive coverage, complete provider choice, predictable costs, travel flexibility, and can afford higher premiums
Medicare Advantage
You want lower monthly costs, don't mind network restrictions, value extra benefits like dental/vision, stay in one area, and prefer an out-of-pocket maximum