Medicare Advantage vs. Medicare Supplement: Clearing the Confusion

Choosing between Medicare Advantage (Part C) and Medicare Supplement (Medigap) is not a “one size fits all” decision. Much like a sports car may not suit a family of six, and a minivan may not suit a single person who loves speed and style, your Medicare plan should fit your personal healthcare needs.

The best way to decide is to plug your expected doctor visits, medications, and procedures into each plan type. That’s where you’ll see your real cost for your healthcare.

What Is Medicare Advantage?

Medicare Advantage (Part C) rolls hospital (Part A) and medical (Part B) coverage into one plan, usually with prescription drugs (Part D). Brokers often call these MAPDs (Medicare Advantage Prescription Drugs). All Medicare advantage plans include a safety net called a "Maximum Out Of Pocket" to prevent you from having to pay after a certain $$ threshold.

• Networks – Advantage plans use provider networks (hospitals, labs, pharmacies, doctors). Always check if your doctors and hospitals are in-network.

• No underwriting – Anyone with Parts A and B can enroll.

• Extras – Many plans include dental, vision, hearing, gym memberships, OTC allowances, or even a Part B premium reduction.

Types of Advantage Plans

• HMO (Health Maintenance Organization): Low premiums (in most cases $0), often higher extra benefits, but you must stay in-network. Referrals to specialists are typically required.

• PPO (Preferred Provider Organization): Allows in- and out-of-network care. Out-of-network usually costs more, and benefits may be a little lower than HMOs.

• MA-Only: Typically the richest benefits (sometimes even rebate Part B premiums), but do not include prescription coverage. If you go without drug coverage for 63+ days, you could face a Late Enrollment Penalty (LEP) when you add Part D later.

  
  

What Is a Medicare Supplement?

Medicare Supplements (Medigap) pair with Original Medicare (Parts A & B). Plans are standardized (Plan A, B, D, G, K, L, N, etc.), with Plan G being the most popular and comprehensive.

• Freedom – No provider networks; see any Medicare-accepting doctor nationwide.

• Stable coverage – Few prior authorizations, no referrals.

• Costs – Pay a higher monthly premium, but out-of-pocket expenses are minimal. For example, in 2025, the Part B deductible is $240; once met, most costs are covered.

• What’s not included – No dental, vision, hearing, OTC, or gym benefits. No prescription drug coverage (you’ll need a separate Part D plan).

• Rates – Premiums vary by carrier, age, and rise about 10–15% yearly. Plan G at age 65 is roughly $150/month to start.

• Underwriting – Generally required unless you’re in your initial enrollment window.

  
  

Putting It Into Practice

• If you have multiple specialists, upcoming surgeries, or frequent hospital stays → a Supplement may give more peace of mind.

• If you’re generally healthy, see the doctor rarely, and want to save money month-to-month → an Advantage plan may make sense.

• Switching later isn’t always easy — Advantage has no underwriting, but Supplements usually do. If you try to get on to a supplement plan after you receive a diagnosis then you may be denied in the underwriting process.

That’s why it’s wise to review your health, budget, and priorities with a licensed, unbiased broker — it costs you nothing and can save you a lot of confusion.

Quick Recap: Pros & Cons

Medicare Advantage (Part C)

✅ Low or $0 premiums

✅ Extra perks (dental, vision, gym, OTC, etc.)

✅ Annual out-of-pocket maximum

❌ Must use networks (or pay higher cost for out-of-network with PPO's)

❌ Copays/coinsurance can add up

❌ Benefits and costs change annually

❌ Part D penalty risk with MA-Only plans

Medicare Supplement (Medigap)

✅ See ANY Medicare provider nationwide (including MAYO CLINIC)

✅ Predictable costs and stable benefits

✅ No referrals or complex authorizations

❌ Higher monthly premiums (rising with age)

❌ No extras (dental, vision, hearing, gym)

❌ Requires separate Part D plan

❌ Underwriting required outside initial enrollment

All thought and opinions expressed herein are derived from real life experiences with my clients as a health insurance broker and not to be replaced by information directly from "MEDICARE".