Medigap vs. Medicare Advantage: which path Is right for you?

You understand Original Medicare and know the enrollment timeline. Now comes the big decision: how will you fill the gaps in your Medicare coverage?

You have two main paths, and neither is inherently "better" — it depends on your individual needs. Let's break down both options.

Path 1: Medigap plans

Medicare Supplement plans work alongside Original Medicare to cover out-of-pocket costs like deductibles, co-insurance, and co-payments.

How it works

You keep Original Medicare, add a Medigap plan, and add a separate Part D plan for prescriptions. When you receive care, Medicare pays its share, your Medigap plan pays its share, and you typically have minimal out of pocket costs left to pay.

The advantages

• Freedom to see any doctor who accepts Medicare: no networks, no referrals
• Predictable costs with minimal out-of-pocket expenses
• Works anywhere in the U.S.
• Plans are standardized — compare prices for identical coverage

The considerations

• Higher monthly premiums
• Need separate prescription coverage (Part D)
• No extra benefits like dental or vision

Who it's good for

People who want complete doctor choice, travel frequently, see specialists regularly, or prefer predictable costs.

Path 2: Medicare Advantage plans (Part C)

Medicare Advantage is an all-in-one alternative to Original Medicare, offered by private insurance companies.

How it works

You're still enrolled in Medicare, but a Medicare Advantage plan provides all your coverage. The plan handles everything, instead of Medicare paying directly.

The advantages

• Lower monthly premiums (many have $0 premiums)
• Built-in prescription coverage (usually)
• Extra benefits like dental, vision, hearing, and fitness
• Out-of-pocket maximum caps your annual costs

The considerations

• Network restrictions — you may pay more or get no coverage out-of-network
• May require referrals and prior authorization
• Co-pays and co-insurance can add up

Who it's good for

People who want low premiums, value extra benefits, are comfortable with networks, and don't travel extensively outside their local area.

Quick comparison

Cost:

Supplement = higher premiums, lower care costs
Advantage = lower premiums, higher care costs

Doctors:

Supplement = any Medicare doctor
Advantage = network-based

Prescriptions:

Supplement = separate Part D needed
Advantage = usually included

Travel:

Supplement = works nationwide
Advantage = service area limited

Making your decision

Consider these questions:

• Do you have preferred doctors you want to keep seeing?
• Do you travel frequently or split time between locations?
• Can you afford higher premiums for lower out-of-pocket costs?
• Are extra benefits like dental and vision important?
• Do you see specialists regularly?

You can change your mind

During the Annual Enrollment Period (October 15 - December 7), you can switch plans if your needs change. However, switching from Medicare Advantage to a Medigap plan after your Initial Enrollment Period may require medical underwriting.

Let LMIA help you decide

LMIA’s Medicare specialists will review your situation, explain how different plans work in your circumstances, compare costs and benefits, and help you enroll in the right plan — with no pressure.

We're not here to sell you the most expensive plan. We're here to find the right fit for your life.

Ready to explore your Medicare options? Contact LMIA today to schedule a consultation with a Medicare specialist who'll help you make a confident, informed decision.