| Question | Original Medicare + Medigap | Medicare Advantage |
|---|---|---|
| How do I receive Part A & B benefits? | Through Original Medicare. Medigap helps with certain costs left by Original Medicare. | Through a Medicare-approved private plan that provides Part A and Part B benefits. |
| Provider access | Generally any doctor or hospital in the U.S. that accepts Medicare. | May require use of plan networks/service areas for non-emergency care; rules vary by plan type. |
| Prescription drugs | Usually a separate Part D plan is needed. Medigap policies sold after 2005 do not include prescription drug coverage. | Most plans include Part D drug coverage. |
| Monthly premiums | You continue paying Part B, plus a Medigap premium and usually a separate Part D premium. | You continue paying Part B and may pay an additional plan premium. Premiums vary by plan. |
| Cost sharing when receiving care | Depends on the Medigap lettered plan; Medigap can reduce certain Original Medicare deductibles, copays and coinsurance. | Copayments, coinsurance and deductibles vary by plan and service. |
| Annual medical out-of-pocket maximum (MOOP) | Original Medicare has no yearly out-of-pocket maximum by itself; Medigap can substantially reduce certain Part A/B cost sharing depending on the policy. | Medicare Advantage plans have a yearly maximum out-of-pocket (MOOP) limit on the amount you pay for covered Part A and Part B services. Once you reach your plan's MOOP, you pay nothing for covered Part A and Part B services for the rest of the calendar year. The MOOP is a limit on your cost sharing—not a limit on the number or amount of covered services you may receive. Some plans may have different in-network and out-of-network limits. |
| Prior authorization | Original Medicare generally does not require insurer prior authorization in the same way Medicare Advantage plans may, though Medicare coverage rules still apply. | Plans may require prior authorization for certain services. |
| Extra benefits | Medigap generally focuses on helping with Original Medicare cost sharing. It usually does not cover routine dental, vision, hearing aids or long-term care. | Plans may offer extra benefits such as dental, vision or hearing; benefits vary by plan. |
| Travel | Original Medicare generally works nationwide with providers that accept Medicare. Some Medigap plans include limited foreign-travel emergency benefits. | Non-emergency coverage can depend on the plan's network and service area; emergency/urgent rules differ. |
| Can I have both? | No. Medigap supplements Original Medicare and cannot be used to pay Medicare Advantage copays, deductibles or premiums. | |
What makes Medigap different?
Medigap policies are standardized in most states. Plans with the same letter provide the same basic standardized benefits regardless of which company sells them, although premiums can differ. The one-time federal Medigap Open Enrollment Period generally begins the first month you are age 65 or older and enrolled in Part B and lasts six months.
After that period, an insurer may be allowed to use medical underwriting unless you have a guaranteed-issue right or other protection. Federal law provides guaranteed-issue rights in certain circumstances, and states may provide additional protections.
What makes Medicare Advantage different?
Medicare Advantage plans are renewed annually and can differ in premiums, networks, drug formularies, cost sharing and extra benefits. A plan that works well one year should still be reviewed the next year because benefits, provider networks, drug coverage and costs can change.
Which is better?
There is no single answer for everyone. The choice depends on your providers, medications, travel patterns, budget, comfort with networks and prior authorization, and the importance you place on predictable cost sharing versus lower monthly premiums.
Before switching from one path to the other
- Confirm the enrollment period that allows the change.
- If leaving Medicare Advantage for Original Medicare, determine whether you can obtain Medigap before dropping other coverage.
- Check whether you will need a separate Part D prescription drug plan.
- Review guaranteed-issue or trial-right protections that may apply.
Official Medicare resources
Medicare rules can change. These pages were written from current Medicare.gov guidance and should be reviewed periodically.