The short version
| Medicare Advantage (Part C) | Original Medicare + Medigap | |
|---|---|---|
| Doctors | Usually a network (HMO or PPO) | Any provider in the U.S. that takes Medicare |
| Monthly premium | Often low or $0, plus your Part B premium | Medigap premium plus Part B premium |
| Cost when you use care | Copays and coinsurance, up to a yearly in-network cap | Low or none, depending on the Medigap plan |
| Drug coverage | Usually built in | Separate Part D plan |
| Extras | Often dental, vision, hearing | Generally not included |
| Prior authorization | Common for some services | Rare under Original Medicare |
Who tends to fit which
Advantage plans often work for people who are healthy, comfortable with a local network, and want the lowest fixed monthly cost. Medigap tends to fit people who travel, split time between states, see specialists at a particular hospital system, or want to know almost exactly what a bad year will cost.
That is a pattern, not a rule. Two neighbors with the same income can land in different places because one sees a specialist across the state line.
Why timing matters more than the brochure
Your Medigap Open Enrollment Period is a one-time, 6-month window that starts the first month you have Part B and are 65 or older. During it, an insurer can’t turn you down or charge you more because of your health.
After it ends, in most states, insurers can use medical underwriting. That means someone who picks Medicare Advantage at 65 and wants to move to Medigap at 72 may get declined or priced higher. There are exceptions, called guaranteed issue rights, including a trial right if you joined Advantage when first eligible and leave within the first year. Some states add their own protections.
Our honest take: if you think there’s a real chance you’ll want Medigap later, make that decision inside the 6-month window. Switching from Medigap to Advantage is easy. Going the other way often isn’t.
Questions to ask any agent
- Are my doctors and my hospital in network for next year, not just this year?
- What is the in-network maximum out-of-pocket, and what does a hospital stay cost me?
- Are my prescriptions on the formulary, and at what tier?
- Which services need prior authorization?
- How many organizations and plans do you represent in my area?
That last one is required disclosure for agents and marketers like us. If someone won’t answer it, that tells you something.
- Medicare.gov: Get ready to buy (Medigap)
- Medicare.gov: Choosing a Medigap Policy (PDF)
- Medicare.gov: Understanding Medicare Advantage Plans (PDF)
This guide is general information, not personal advice. Plan availability, costs and rules vary by state and carrier.
