Medicare Advantage vs. Medigap: How I Help Clients Decide
"Should I get Medicare Advantage or Medigap?"
That's the question I hear more than any other in my office.
After more than 15 years helping Medicare beneficiaries compare these two paths, here's how I actually think through it with clients — including the situations where I still recommend Medicare Advantage, even though I generally lean toward Medigap for people who can comfortably afford it.
Before I get into my own opinion, one thing up front: this isn't a one-size-fits-all answer.
Medicare Advantage is a genuinely good fit for some people. Medigap is a better fit for others. My goal here is to explain why, not to talk you into either one.
Medigap generally costs more per month but gives you predictable costs, no networks, and no prior authorizations.
Medicare Advantage generally costs less per month (often $0), though the maximum allowed in-network out-of-pocket limit is $9,250 in 2026 — individual plans may set a lower limit.
If you can comfortably afford a Medigap premium and want to lock in stability, I usually recommend it. If budget is the deciding factor, Medicare Advantage still fills an important role.
This guide is written primarily for people enrolling in Medicare for the first time, or deciding between Original Medicare plus Medigap and Medicare Advantage.
Questions I Ask Every Client
Before I recommend either option, these are the questions I ask every Medicare beneficiary who sits down with me.
- Can you comfortably afford a monthly Medigap premium?
- How often do you travel?
- Do you have specialists you want to keep seeing without a referral?
- Would an unexpected $5,000 medical bill create financial stress?
- Do you prefer predictable monthly costs, or a lower monthly premium?
- Are you comfortable reviewing your coverage every fall?
Your answers to those questions usually make the right choice a lot clearer than any pros-and-cons list can.
Medicare Advantage: Pros and Cons
If you want the full breakdown, we cover Original Medicare vs. Medicare Advantage in more depth on our main page. Here's the short version.
Pros
- Monthly premiums are often low or $0, and most plans bundle in prescription drug coverage.
- Many plans include extras like gym memberships, and dental or vision discounts.
Cons
- The maximum allowed in-network out-of-pocket limit is $9,250 in 2026, though individual plans may set it lower. This generally doesn't include your Part B premium, plan premium, prescription drug costs, or non-covered services — and PPOs often have a separate, higher combined limit for out-of-network care.
- Plans and networks can change from one year to the next. Doctors and hospitals can leave a network, or the plan itself can be discontinued in your county.
- Many services require prior authorization before they're approved.
- Traveling outside your network can be limited, especially on an HMO. A PPO gives you more flexibility to go outside the network, though usually at a higher cost.
Here's what prior authorization actually looks like in practice.
Say your doctor orders an MRI after you develop severe back pain.
Under Original Medicare with a Medigap plan, Medicare generally determines whether the service is covered.
Under many Medicare Advantage plans, the insurer may require approval before the MRI happens.
Many approvals happen quickly. Others can take longer, depending on the service and the plan.
One reason I've grown more cautious about Medicare Advantage over the past few years is what our office experienced during the 2025, 2026, and now 2027 Annual Enrollment Periods — more on that here.
We spent much of those enrollment seasons helping beneficiaries whose plans were discontinued, whose networks and benefits shifted, or who needed to pick entirely new coverage after a carrier pulled back.
We weren't just helping people compare premiums — we were helping them find new doctors, verify hospitals were still in-network, and understand how their benefits had changed after their old plan ended.
That's not me trying to scare anyone off Medicare Advantage. It's just why I tell clients to expect to actively review their plan every single year.
Medicare Supplement (Medigap): Pros and Cons
Pros
- The Medigap carrier doesn't impose its own prior authorization requirements — Original Medicare's coverage rules still apply.
- Complete network freedom — you can see any provider that accepts Original Medicare, anywhere in the country, no referrals required.
- Benefits stay the same year after year. There are no annual network or plan-design changes to track.
- Lower, more predictable out-of-pocket costs.
Cons
- Monthly premiums run higher — often $150–$250+ depending on your state and age.
- You'll need a separate stand-alone Part D plan for prescription drug coverage.
Plan G is the most popular Medigap option today — see our Plan G guide for details. If the premium feels steep, High Deductible Plan G is worth a look too — it's become a lot more competitive in the last couple of years.
Cost Comparison at a Glance
Here's how the two options typically compare side by side.
| Medigap (Plan G) | Medicare Advantage | |
|---|---|---|
| Monthly premium | Higher | Often lower or $0 |
| Doctor visits | Usually $0 after Part B deductible | Copay or coinsurance, varies by service and plan |
| Hospital stays | Predictable, covered after deductible | Copay or coinsurance |
| Medical cost exposure | Generally just the annual Part B deductible for Medicare-covered services | Copays and coinsurance up to the plan's annual limit for in-network covered Part A and B services |
| Prescription drug plan | Separate Part D plan required | Usually included |
| Prior authorization | Generally determined under Original Medicare rules — the Medigap carrier doesn't separately approve care | Frequently required for certain services, depending on the plan |
| Network | None — any provider accepting Medicare | Yes — HMO or PPO network rules apply |
Costs vary by Medigap plan. Plan N includes certain copays and doesn't cover Part B excess charges, and High Deductible Plan G requires you to meet its own deductible first — the table above reflects standard Plan G, the most commonly chosen plan.
Medigap generally requires a higher, predictable monthly expense, while Medicare Advantage may expose you to more point-of-service costs during a year in which you need substantial care.
Sample Medigap Plan G Premiums
Quotes shown are examples for illustration only. Actual premiums vary by ZIP code, age, gender (where permitted), tobacco use, household discounts, and carrier pricing.
| Company | Florida | Iowa | Indiana |
|---|---|---|---|
| Cigna HealthSpring | $204.39 | $189.48 | $143.09 |
| Mutual of Omaha | $227.25 | $193.88 | $143.52 |
| Aflac | $228.20 | $149.59 | $146.13 |
| Aetna | $280.47 | $192.09 | $172.26 |
Florida consistently runs higher than most other states for Medigap premiums, though rates vary by company, age, and household discounts. This gives you a general sense of the range, not an exact quote — get your ZIP code quote.
On the Medicare Advantage side, KFF found that a majority of Medicare Advantage enrollees with drug coverage pay no premium beyond the standard Part B premium. The remaining enrollees may pay anywhere from a few dollars to over $100 a month, depending on the plan and county.
Don't Overlook High Deductible Plan G
One thing I encourage many clients to consider is High Deductible Plan G.
Many people compare a $0 Medicare Advantage premium to a $200-a-month standard Plan G premium and assume those are their only two choices.
They're not.
In many parts of the country, High Deductible Plan G premiums run well under $100 a month — sometimes lower — while still providing the nationwide provider access and stable benefits that many people value in a Medigap plan.
The trade-off is that you'll pay more out of pocket before the plan starts paying benefits. Once you meet the annual High Deductible Plan G deductible, it provides the same standardized benefits as a regular Plan G.
For many beneficiaries, the monthly premium for High Deductible Plan G can be much closer to a Medicare Advantage plan than to standard Plan G, making it an important third option to evaluate — not just a fallback for people who can't afford full Plan G.
| Medicare Advantage | High Deductible Plan G | Standard Plan G | |
|---|---|---|---|
| Monthly premium | Lowest — often $0 | Moderate | Highest |
| Network | HMO or PPO rules apply | None | None |
| Prior authorization | Often required | No additional Medigap requirement | No additional Medigap requirement |
| Cost pattern | Lower premium, higher point-of-service costs | Higher deductible, then standardized coverage | Predictable costs after the Part B deductible |
Over the past few years, I've found myself discussing High Deductible Plan G much more often with clients who like the idea of Medigap but are hesitant about paying a full Plan G premium.
For many healthy retirees, it's a middle ground worth considering before deciding between Medicare Advantage and a standard Plan G.
When I Still Recommend Medicare Advantage
I lean Medigap for clients who can afford it — but Medicare Advantage is genuinely the right call for a lot of people, and I tell them so.
- Your budget won't comfortably stretch to a Medigap premium every month.
- You rarely travel outside your local area.
- Your regular doctors and hospitals already participate in a plan's network.
- You're comfortable reviewing your coverage every fall during the Annual Enrollment Period.
- You're in good health and understand that a future switch to Medigap may require answering health questions.
Many of my clients choose Medicare Advantage simply because it's the option that fits their budget. That's a completely reasonable reason to choose it.
The Underwriting Risk Most People Don't Consider
This is the part most agents don't spend enough time on.
When you first enroll in Medicare, you get a one-time Open Enrollment Period (Medicare.gov). During that window, you can enroll in any Medigap plan without answering health questions.
Outside of that window, switching into a Medigap plan later usually requires medical underwriting — meaning the insurance company can review your health history and may decline your application, based on the rules allowed in your state.
There are exceptions. Guaranteed issue rights — explained in more detail by CMS.gov — can apply in certain situations, such as losing other coverage through no fault of your own.
Here's the scenario I see play out: someone enrolls in Medicare Advantage at 65 while healthy, then develops a health condition a few years later and decides they'd prefer Medigap's predictability. In many states, they may no longer qualify medically.
Several states have their own guaranteed issue protections or "birthday rules" that make switching Medigap plans easier than in most of the country — check your state's Department of Insurance for current rules.
The general underwriting caution above applies to most beneficiaries, but it's worth checking your own state's rules before assuming you're locked in — or locked out.
If Medigap is something you believe you may want long term, your initial Medigap Open Enrollment Period is usually the safest time to enroll, because your acceptance doesn't depend on your health history.
Which Option Fits You?
Medigap may fit if:
- Predictable costs matter more to you than the lowest monthly premium.
- You travel, or split time between states.
- You see specialists regularly and want to avoid referrals.
- You'd rather avoid prior authorizations altogether.
- You can comfortably afford the premium long-term.
Medicare Advantage may fit if:
- Premium is the deciding factor in your budget.
- You don't mind working within a provider network.
- Your current doctors already participate in a plan you like.
- You're comfortable reviewing your coverage every year.
Here's a short way I explain the difference to clients: Medicare Advantage is closer to paying less each month but sharing more of the cost when you actually use care. Medigap is closer to paying more every month in exchange for fewer, more predictable medical bills.
Common Misconceptions
"Medicare Advantage is free."
The premium may be $0, but you still pay your Part B premium. You can also face copays, coinsurance, and deductibles depending on the care you need.
"Medigap covers prescription drugs."
It doesn't. You'll need a separate Part D plan alongside it.
"I can switch to Medigap whenever I want."
Not always. In most states, medical underwriting applies once your initial enrollment window has passed, unless you qualify for a guaranteed issue right.
Important Costs Not Shown in the Monthly Premium
Regardless of which option you choose, you'll generally keep paying your Medicare Part B premium.
With Medigap, you'll also usually pay a separate Part D premium, and may have drug deductibles and copays on top of that.
With Medicare Advantage, a $0 plan premium doesn't mean your healthcare is free. You may still have copays, coinsurance, deductibles, drug costs, and expenses for services the plan doesn't cover.
No article can tell you which option is best for your individual situation. The right choice depends on your health, budget, travel habits, provider preferences, and where you live.
Bottom Line
If you can comfortably afford the premium and you value predictable costs, provider freedom, and no prior authorizations, I generally recommend looking closely at Medigap — ideally during your initial enrollment window, while you still qualify without underwriting.
If your budget is the deciding factor, or you rarely travel and your doctors are already in-network, Medicare Advantage can be a smart, reasonable choice — just plan on reviewing it every fall.
Both of my parents and my in-laws are on Medigap plans. Every year, I review it with them the same way I'd review it with any client.
If they're still happy with their coverage and can comfortably afford the premium, I generally don't recommend changing solely to lower their monthly payment. They've appreciated that approach.
If you'd like a closer look at how Medigap companies compare on price, our comparison chart is a good next stop. If you want help thinking through your own situation, reach out — we're happy to walk through it with you.
FAQs
- Can I have both Medicare Advantage and a Medigap plan?
- Which is cheaper, Medicare Advantage or Medigap?
- Do all Medigap plans cover the same things?
- What happens if I choose Medicare Advantage and later want to switch to Medigap?
- Can I change my mind during the Medicare Advantage Open Enrollment Period?
