Medicare Advantage VS Medigap: The Pros and Cons

The Medicare Advantage plan and the Medigap plans have their pros and cons. Here’s more about these plans to help you compare and make an informed decision.
Stethoscope and a red cross

Medicare is essential to cover up your medical expenses and help you financially to lead a happy and healthy life. Since your expenses would include the hospital costs as well as the cost of the prescription drugs, you can increase the coverage of your Original Medicare plan. You have the option to go for the Medical Advantage plan or the supplemental Medigap plans. Here’s more about these plans along with their pros and cons to help you compare and make an informed decision. ~ Ed.

Doctor in hospital attending a patient under a Medicare plan

For many people, a Medicare plan is a life-saver.

Doctor appointments and medical checkups don’t need to be postponed or canceled for fear of becoming financially drained anymore. They can get the care they need as soon as they start feeling ill, and that in turn provides them with a greater quality of life.

As beneficial as it is, Original Medicare plans still have many loopholes. These plans usually only cover hospital costs, oftentimes requiring certain deductibles that can quickly add up.

They also don’t cover the cost of prescription drugs, which can quickly become financially draining.

To solve this gap, as explained on, alternative options have been proposed.

People seeking increased coverage can either enroll in a Medical Advantage plan or supplement their Original Medicare plan with Medigap. Each plan has its pros and cons, making the final choice up to the patient and their preferences.

To understand the options you have, you should know how each plan works and what it covers over the Original Medicare plan. Here’s what you need to know:


Medicare Advantage Plan

One of the flaws in an Original Medicare plan is that it includes both deductible and co-payment.

With increased hospital visits and medical care, this can quickly add up to reach thousands of dollars annually.

Medicare Advantage plan takes care of this flaw, in addition to covering the costs of prescription drugs as well.

Instead of walking around with different kinds of insurance to cover different services, a Medicare Advantage plan will combine parts A, B, and D of the Medicare plan into one card. In return, you give up your right to enroll in a Medicare plan.

Medicare Advantage Plan Pros

  1. The plan requires lower monthly premiums compared to an Original Medicare plan plus supplemental plans to cover the gap (Medigap).
  2. It includes Part D of Medicare, which covers the costs of prescription drugs.
  3. One provider covers all of your insurance needs.
  4. The plan offers additional benefits, such as insurance on dental and vision care. Some plans even offer gym memberships.

Medicare Advantage Plan Cons

  1. You have a limited network of physicians to work with, ones that accept Medicare Advantage insurance.
  2. The plans can change annually, resulting in a variety of coverage and overall costs.
  3. The plan is capped in its coverage range, resulting in fluctuating out-of-the-pocket expenses quickly in extensive medical care needs.
  4. To enroll in or out of the plan, you have a narrow window starting from October 15 to December 7 of every year. If you miss your window, you won’t be able to change your plan.

Medigap Plan

A Medigap Plan requires an active subscription in the Original Medicare plan, and it serves in filling the gaps of the original plan.

There are 10 different plans of Medigap, each covering certain gaps. Some plans have limited additional coverage to the original plan, while others offer full coverage.

Medigap Plan Pros

  1. Your physician network is not limited. If the hospital or institute you’re seeking treatment at accepts Medicare plans, then they’ll accept Medigap as well.
  2. No matter where you get your Medigap plan from, you’ll rest assured that all Medigap plans are identical. That’s because they’re standardized plans across all providers.
  3. The only case that your Medigap plan will be deactivated is when you fail to pay the premium. Otherwise, the plan is automatically activated, even if your plan is no longer offered in that year.
  4. No need for filing paperwork, as all of their insurers provides electronic services to handle your affairs.
  5. By choosing Medigap plans that completely cover the gaps in the Original Medicare plan, you won’t have to suffer from unexpected costs piling up on you.

Medigap Plan Cons

  1. In exchange for comprehensive coverage, you’ll pay higher monthly premiums to maintain your Medigap plan in addition to the Original Medicare.
  2. Most Medigap plans don’t cover the cost of prescription drugs.
  3. Only 2 plans completely cover out-of-pocket expenses, which are Plans F and G.
  4. There’s a limited timeframe for getting your Guaranteed Issues Right protection. If you miss it, you risk having your coverage denied.

Summing Up

Many people seek supplemental plans to cover the gaps in their Medicare plans. The two options they have are either to enroll in a Medicare Advantage plan or a Medigap plan.

Their choice should be based on their medical needs and which plan works best for them.

For healthy individuals who rarely require any hospital check-ins or medical care, a Medicare Advantage can prove to be better.

However, individuals with chronic conditions or deteriorating health will be more comfortable with Medigap plans.

Over to you

Have you enrolled in the Medicare Advantage plan or the Medigap plans? Do share your thoughts and experiences about these plans.


Disclaimer: We're not offering any medical advice here. These ideas are for educational and entertainment purposes only. Always seek a professional medical opinion from a physician of your choosing before making any medical decision. The information provided here is not intended to be a substitute to the advice given by your physician or another healthcare professional.

Disclaimer: Though the views expressed are of the author’s own, this article has been checked for its authenticity of information and resource links provided for a better and deeper understanding of the subject matter. However, you're suggested to make your diligent research and consult subject experts to decide what is best for you. If you spot any factual errors, spelling, or grammatical mistakes in the article, please report at [email protected]. Thanks.

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  1. So for someone like me, Medical Advantage is the better option. I rarely need to go to the hospital. Thanks

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