Becoming Medicare eligible and trying to understand the various aspects of Medicare, let alone choosing a plan, can be a little daunting. Adding to the confusion is the fact that you’re being bombarded by every insurance company under the sun offering Medicare plans of one sort or another. Many people find themselves at the cross roads of trying to decide between enrolling in a Medigap plan or Medicare Advantage plan. Which coverage option is better? The answer really depends on your specific situation and needs. Below we look at the pros and cons of both options to help you decide which plan type is best for you (if you're still a little hazy about how Medicare works, check out our Medicare 101 page for a quick overview). NOTE: the terms "Medigap" and "Medicare supplement" mean the same thing and are often used interchangeably.

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* Medicare supplement plans F and G are also offered as high‑deductible plans by some insurance companies in some states. If you choose this option, this means you must pay for Medicare‑covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,950 in 2026 before your policy pays anything. 

**For Plans K and L, after you meet your out‑of‑pocket yearly limit and your yearly Part B deductible ($283 in 2026), the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission. 

Pros and Cons of Medigap Plans

The pros: The main reason why these plans are popular is because of their portability in that a policy holder can take their plan anywhere in the U.S. to any provider who accepts Medicare. There are no network restrictions and there are no referrals required to see specialist doctors. Medigap plans in general offer more freedom and flexibility compared to Medicare Advantage plans. 

Pros and Cons of Medicare Advantage plans

Pros: Medicare Advantage plans have become increasingly popular over the years for a variety of reasons. As previously noted, the premiums will be considerably lower than Medigap plans and many Medicare Advantage plans include Part D coverage. Copays are fairly nominal under most plans for everything from doctor office visits to diagnostic testing, rehabilitation, outpatient surgeries and inpatient hospitalization. Plus, they may also include extra benefits for things that Medicare doesn’t cover - which can go a long way in helping their plan members stay healthy, active and save money on other qualified products & services. Medicare Advantage can be a good option for people who are looking to save money but still want a health plan with robust benefits.

Cons: With a few exceptions, Medicare Advantage plans are network based plans. A majority of Medicare Advantage plans are HMO’s which tend to be network restrictive. As with most HMO plans, if you go out of the network for routine care you will be responsible for the entire cost (NOTE: emergency care is covered in-network for all Medicare Advantage plans regardless of where it occurs). There are Medicare Advantage PPO plans offered in a few areas, but they tend to have higher premiums and out-of-pocket costs compared to HMO plans. And even though PPO plans will cover you in the event that you want to see an out of network provider, the out of network costs can be up to 50% of charges - which could be too expensive for some people.

Things To Consider Regarding Medicare Advantage Plans

Because most Medicare Advantage plans are network based, it is strongly recommended that enrollees obtain services within the plan’s network. Otherwise, you could end up with much higher out of pocket expenses than you anticipated. Here are some examples of non-network cost sharing an enrollee may experience on different Medicare Advantage plan types: 

Example 1: If you are enrolled in a Medicare Advantage HMO or EPO plan, non-emergency services rendered out of network are not covered at all – even if the provider has an agreement with Medicare to receive payments.

Example 2: If you are enrolled in a Medicare Advantage PPO plan and you see a provider outside the preferred provider network, you may be responsible for up to 50% of the cost (except for emergencies). The out of pocket limit for non-network services can be significantly higher then the in-network out of pocket limit.

Example 3: If you are enrolled in a Medicare PFFS (Private Fee For Service) plan and you receive services from an out of network provider, you could be responsible for up to 15% over what Medicare typically allows (assuming the provider has accepted the plan’s terms and conditions).

Before deciding on any Medicare Advantage plan, be sure to do your due diligence and make sure the medical providers you wish to see will accept the plan(s) you are considering. This could be the difference between a health plan that meets all of your needs versus having your health care choices adversely impacted. If you need help researching plan networks, please feel free to call us at: (877) 888-6315 or tap here to make an appointment at a time that's convenient for you. Our services are offered at no cost or obligation to you.

The Bottom Line

Some people may find that their doctors are already in a Medicare Advantage network and they would prefer to save on monthly premiums. They may also be attracted to the ‘extra benefits’ that a Medicare Advantage plan offers. In these cases a Medicare Advantage plan will work very well. On the other hand, some people may have doctors who are not in any networks and/or they may do a lot of traveling. They may also live in more remote areas where Medicare Advantage networks are very limited or none at all. In these cases a Medigap plan is much more appropriate. Typically, the right plan option comes down to three things: doctors, drugs and affordability. The questions you need answered when considering any health plan are: Will all of your doctors accept this plan? If not, would you be willing to change any of your doctors? Are all of your medications covered and at reasonable copays? Is the monthly premium(s) affordable or will it leave you strapped at the end of every month? 

If you have more questions or need help with your Medicare coverage, we’re here to help. We offer free personalized health insurance counseling to help you understand your coverage options. We’ll also help you research your preferred medical providers along with any medications you may be taking so that you can make informed decisions regarding your Medicare coverage. And to top it off, our services are offered at no cost or obligation to you!

Call us at (877) 888-6315, or tap here to set an appointment at a time that's convenient for you. 

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