Key Takeaways

• In 2025, Medicare Advantage and Medicare Supplement (Medigap) plans continue to offer vastly different structures for covering healthcare costs. Understanding how each plan handles provider access, costs, and enrollment timing is essential.

• You cannot enroll in both Medicare Advantage and Medigap. Choosing one locks out the other, so the decision must align with your healthcare needs, travel habits, and long-term budget expectations.

Start with the Basics: What Each Plan Type Offers

When you’re eligible for Medicare, you have two primary options beyond Original Medicare (Parts A and B): Medicare Advantage (Part C) and Medicare Supplement (Medigap). While both aim to reduce your out-of-pocket expenses, they function very differently.

Medicare Advantage Plans

Medicare Advantage replaces your Original Medicare. It is administered through private companies approved by Medicare and must cover all Part A and Part B services.

• Often includes additional benefits such as routine dental, vision, and hearing.

• Typically uses provider networks like HMOs or PPOs.

• Requires copayments or coinsurance for most services.

• Usually includes built-in Part D prescription drug coverage.

• Has an annual maximum out-of-pocket limit.

Medicare Supplement (Medigap) Plans

Medigap works alongside Original Medicare. It helps pay for expenses such as copayments, coinsurance, and deductibles not covered by Parts A and B.

• You keep Original Medicare coverage and add a Medigap policy.

• No networks; see any provider that accepts Medicare nationwide.

• Does not include prescription drug coverage—you’ll need a separate Part D plan.

• Often has higher monthly premiums but minimal out-of-pocket costs at the point of care.

Coverage Access: Nationwide vs. Network-Based

One of the biggest functional differences is how you access care.

• Medicare Advantage generally limits you to a regional provider network. You may need referrals to see specialists, and going out-of-network can lead to higher costs or no coverage at all (especially in HMO plans).

• Medigap allows you to visit any doctor or facility in the U.S. that accepts Medicare. There are no referrals required, making it ideal for frequent travelers or snowbirds who split time between states.

Prescription Drug Coverage Isn’t Equal

In 2025, Medicare Advantage plans typically include prescription drug coverage (Part D) as part of the package. This is convenient, but:

• You are limited to the plan’s specific drug formulary and preferred pharmacy network.

• Any changes in the plan’s drug coverage could impact you annually.

With Medigap, prescription drugs are not included. You must enroll in a standalone Part D plan.

• This gives you more flexibility in choosing a Part D plan that aligns with your medications.

• However, it adds another premium and plan to manage.

Out-of-Pocket Costs Vary Widely

It’s not just about monthly premiums—it’s about your total spending over the year.

• Medicare Advantage plans usually have lower monthly premiums than Medigap plans but require you to pay copayments or coinsurance for nearly every service. These costs add up quickly if you use healthcare often.

• Medigap plans have higher premiums, but many pay nearly all remaining costs after Medicare. This can mean near-zero expenses when you visit a provider.

In 2025, Medicare Advantage plans are required to cap your annual in-network out-of-pocket spending, which can be as high as $9,350. Medigap plans, depending on type, can reduce your out-of-pocket medical expenses to virtually none.

Enrollment Windows Are Not Always Equal

If you choose a Medicare Advantage plan and later want to switch to Medigap, timing matters.

• You have a one-time Medigap Open Enrollment Period that lasts for 6 months starting the month you are 65 or older and enrolled in Part B. During this time, insurers cannot deny you coverage or charge you more based on health.

• After that, if you want to enroll in a Medigap plan, you may face medical underwriting unless you qualify for a Special Enrollment Period.

Medicare Advantage plans offer more regular switching opportunities. You can make changes during:

• Annual Enrollment Period (AEP): October 15 to December 7

• Medicare Advantage Open Enrollment Period: January 1 to March 31

Travel and Emergency Care Flexibility

For those who travel extensively or spend part of the year in another state, flexibility matters.

• Medicare Advantage plans usually do not cover routine care outside your plan’s service area, unless it’s an emergency.

• Medigap offers coverage anywhere in the U.S. where Medicare is accepted. Some plans even offer limited emergency coverage outside the U.S.

Prior Authorization and Plan Rules

Medicare Advantage plans often require prior authorization for services like MRIs, surgeries, or certain medications. These delays can cause frustration or postponed care.

Medigap plans don’t require prior authorization. If Medicare covers it, your Medigap plan pays its share without extra steps.

What Happens if You Delay Enrollment

• Delaying enrollment in Medicare Advantage doesn’t carry a penalty.

• Delaying enrollment in a Part D plan (which you need if you choose Medigap) can result in a late enrollment penalty if you don’t have other credible prescription drug coverage.

This penalty accrues for every month you go without coverage after your Initial Enrollment Period and is added to your Part D premium permanently.

Premium Predictability vs. Pay-As-You-Go

The structure of your spending will look very different based on the plan you choose:

• Medigap plans give you more predictable monthly costs with fewer surprise bills. This helps those on a fixed budget.

• Medicare Advantage plans have lower monthly premiums, but the cost-sharing at the point of care can fluctuate. This unpredictability may be harder to manage in the long run.

Dental, Vision, and Hearing: Do You Really Need It Built In?

Medicare Advantage plans often market the inclusion of routine dental, vision, and hearing services as a major benefit. However, the coverage can be limited or come with caps and restrictions.

With Medigap, these services aren’t included, but you can purchase standalone dental and vision plans that may offer broader coverage. This allows you to customize based on your actual needs rather than accept what’s bundled.

Changing Health Needs as You Age

Health conditions often change with age. In 2025 and beyond, your plan choice today may not serve you as well in 5 or 10 years.

• Medicare Advantage plans can change coverage, networks, and drug formularies annually. That means what works well this year may not next year.

• Medigap plans offer consistency. Once you’re in, coverage doesn’t change unless you drop the plan. But switching into Medigap later in life may be harder due to underwriting.

This is why many choose Medigap early—while they’re still guaranteed to qualify.

Customer Support and Appeals Processes

If you anticipate needing ongoing support with your coverage, be aware:

• Medicare Advantage plans require appeals for denied services, which can delay care.

• Medigap claims are straightforward. As long as Medicare pays its share, your Medigap plan must pay its portion.

Annual Plan Reviews Are a Must

Every fall, Medicare Advantage and Part D plans release an Annual Notice of Change (ANOC) outlining what’s changing for the next year. Even if you’re happy with your plan, you need to review this document to avoid surprises come January.

Medigap plans don’t issue annual changes to coverage—what you sign up for stays consistent year over year, although premiums can increase.

Final Thoughts to Help You Choose Smartly

Choosing between Medicare Advantage and Medigap isn’t about which plan is better overall—it’s about which fits your life better. Think about:

• How often you need medical care

• Whether you want the freedom to see any doctor

• Your travel habits

• How you prefer to manage healthcare costs

If you’re unsure which option aligns with your needs, it’s wise to reach out to a licensed agent listed on this website. They can help assess your priorities and walk you through your options clearly.