What is the difference between a Medicare Supplement and a Medicare Advantage Plan?
If you’re eligible for Original Medicare, you’ll notice it doesn’t cover everything. That’s why many Medicare beneficiaries explore either Medicare Supplement Plans (Medigap) or Medicare Advantage Plans (Part C) to help manage health care costs like copays, coinsurance, and deductibles.
It’s time to explore the differences.
Medicare Supplement Plans (Medigap)
- Works with Original Medicare coverage: Medigap helps pay for gaps in Medicare Parts A and B, including hospital stays, outpatient services, and deductibles.
- Standardized benefits: Across most states, Medicare Supplement Insurance offers uniform benefits, though monthly premiums vary by insurance company and location.
- Prescription drug coverage: Medigap plans sold after 2006 do not include drugs—you’ll need a separate Medicare Part D plan or prescription drug plan.
- Flexibility: You can see any health care provider who accepts Original Medicare, with no plan’s network restrictions.
- Guaranteed issue: Available during certain periods without medical underwriting or in the case of our home state of New York, it’s always guarantee issue.
Medicare Advantage Plans (Part C)
- Replaces Original Medicare: These private insurance companies combine Medicare Parts A, B, and often Part D into one insurance plan.
- Extra benefits: Some plans include dental, vision, and hearing services, plus wellness perks not offered by Original Medicare.
- Plan types: Options include HMO, PPO plans, Private Fee-for-Service, and Special Needs Plans.
- Costs: Many Medicare Advantage Plans have low or $0 monthly premiums, but you still pay your Part B premium.
- Out-of-pocket limit: Advantage plans cap out-of-pocket costs, protecting you from high out-of-pocket expenses.
- Network rules: Most plans require in-network providers and sometimes referrals for specialists.
- Annual enrollment period: Changes allowed during the Open Enrollment Period (Oct 15–Dec 7) and Medicare Advantage Open Enrollment (Jan 1–Mar 31).
Important 2026 Updates
- Part B premium: $202.90 /month
- Part A deductible: $1,736 per benefit period
- Part D: $2,000 annual cap on prescription drug coverage
- Medicare Advantage: Many plans offer $0 premium options
- Medigap: Plan G averages $145–$155/month; Plan N around $112/month
Frequently Asked Questions
What is the difference between a Medicare Advantage plan and a Medicare Supplement plan?
Medicare Advantage (Part C) replaces Original Medicare and often includes drug coverage and extra benefits, while Medigap works alongside Original Medicare to cover deductibles, copays, and coinsurance.
We like to think of Medicare Advantage as more of a “pay-as-you-go” plan due to the low to no monthly premiums and having to pay copays when you use your benefits. On the other hand, Medicare Supplements are often similar to “Pre-paid” because you have predictable monthly premiums often paired with no additional costs besides the part B deductible for plans like plan g.
What is the downside to Medicare Supplement plans?
Higher premiums and no extra benefits like dental or vision. Plus, you need a separate drug plan for prescriptions.
What is the biggest disadvantage of Medicare Advantage?
Network restrictions and possible out-of-network costs. Plans can change annually, affecting your doctors and benefits.
Can you get a Medicare Supplement if you have a Medicare Advantage plan?
No. You cannot have both at the same time.
Why do some seniors choose Medigap over Medicare Advantage?
Freedom to see any provider nationwide and predictable costs without network limitations.
Can you change from a Medicare Advantage plan to a Medicare Supplement plan?
Yes, but you may face medical underwriting unless you qualify for a guaranteed issue period or live in the state of New York. We have helped over 50,000 New York residents make Medicare choices.
Who is eligible for Medicare Supplement insurance?
Anyone enrolled in Medicare Part A and Part B.
What is the difference between Medicare and Medicaid?
Medicare is a federal program for seniors and certain disabled individuals; Medicaid is a state-run program for low-income individuals.
Need Help Choosing?
Your health care needs, budget, and preference for flexibility vs. network restrictions will determine the best fit.
Whether you want the predictability of Medicare Supplement Plans or the bundled benefits of Medicare Advantage Plans, our licensed insurance agents at Plan Medicare can guide you through plan options, enrollment, and exclusions.
PlanMedicare has offices in New York City and Long Island. Call us today for help or book an appointment.
