One of the most common questions I hear from people turning 65 is: “What’s the difference between Medicare Advantage and Medigap — and which one is right for me?” As an independent Medicare insurance broker serving clients across New York, New Jersey, and nationwide, I help people answer this question every single day. The honest answer is that there is no universally “better” plan — the right choice depends entirely on your health needs, budget, preferred doctors, and lifestyle. Here is a clear, unbiased breakdown to help you decide.

What Is Original Medicare?

Before comparing Medicare Advantage and Medigap, it helps to understand what they are both building on — Original Medicare. Original Medicare consists of two parts:

• Medicare Part A — covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Premium-free for most people who worked at least 40 quarters.
• Medicare Part B — covers outpatient care, doctor visits, preventive services, and medical equipment. The standard premium in 2026 is $202.90 per month.

Original Medicare covers approximately 80% of approved medical costs — leaving the remaining 20% as your responsibility. That 20% is where Medicare Advantage and Medigap come in, each taking a very different approach to filling that gap.

What Is Medicare Advantage?

Medicare Advantage — also known as Medicare Part C — is an alternative to Original Medicare offered through private insurance carriers approved by Medicare. Instead of using Original Medicare directly, you receive your Medicare benefits through the Advantage plan.

How Medicare Advantage Works

Medicare Advantage plans bundle Part A, Part B, and usually Part D prescription drug coverage into one convenient plan. Many plans also include extra benefits not covered by Original Medicare, such as dental, vision, hearing, fitness memberships, and transportation to medical appointments.

Medicare Advantage Costs

Many Medicare Advantage plans have a $0 monthly premium — though you still pay your Part B premium. You pay copays and coinsurance when you use services, and each plan has an annual out-of-pocket maximum that caps your total exposure for the year. In 2026, the out-of-pocket maximum for Medicare Advantage plans is $9,350 for in-network services.

Medicare Advantage Networks

Most Medicare Advantage plans — including HMO plans and PPO plans — have specific networks of doctors and hospitals. HMO plans typically require you to stay in-network and get referrals to see specialists. PPO plans offer more flexibility but cost more when you go out of network.

What Is Medigap?

Medicare Supplement insurance — commonly called Medigap — works alongside Original Medicare to cover the out-of-pocket costs that Original Medicare leaves behind. Unlike Medicare Advantage, Medigap does not replace Original Medicare — it supplements it.

How Medigap Works

When you have a Medigap plan, Original Medicare pays its share first — then your Medigap plan pays some or all of the remaining costs, such as deductibles, coinsurance, and copayments. The result is highly predictable healthcare costs with little to no surprise bills.

Medigap Costs

Medigap plans charge a monthly premium in addition to your Part B premium. Premiums vary by plan type, carrier, age, and location. The most popular plans are Plan G and Plan N. Because Medigap benefits are standardized by the federal government, the coverage is identical from carrier to carrier, which means shopping for the lowest premium is always the right strategy.

Medigap and Prescription Drugs

Medigap plans do not include prescription drug coverage. If you choose Medigap, you will need to add a standalone Medicare Part D plan for prescription drug coverage.

Medigap Freedom of Choice

One of the biggest advantages of Medigap is that it allows you to see any doctor or specialist who accepts Medicare — anywhere in the United States — with no network restrictions and no referrals required. This is particularly valuable for seniors who travel frequently, have complex health needs, or want access to specialists at major academic medical centers.

Medicare Advantage vs Medigap Side-by-Side Comparison

Feature	Medicare Advantage	Medigap
Monthly Premium	Often $0 (plus Part B premium)	Varies — typically $100–$300/month (plus Part B premium)
Doctor Choice	Network restricted	Any Medicare-accepting doctor nationwide
Referrals needed	Usually yes (HMO)	No
Drug Coverage	Usually included	Not included — need separate Part D
Extra Benefits	Dental, vision, hearing, fitness	Not included
Out-of-Pocket Maximum	Up to $9,350 in-network (2026)	Very low — Plan G covers most costs
Predictability of Costs	Variable — copays per service	Very predictable
Travel Coverage	Limited to service area	Nationwide coverage
Plan Changes	Can change annually during AEP	May require medical underwriting to switch

Who Should Choose Medicare Advantage?

Medicare Advantage may be the right choice if you:

• Want a lower monthly premium and are comfortable with network restrictions
• Are generally healthy and don’t anticipate frequent medical visits
• Want extra benefits like dental, vision, and hearing coverage
• Have a limited budget and want to minimize monthly costs
• Are comfortable with copays and coinsurance per service
• Live in an area with strong Medicare Advantage plan options

Who Should Choose Medigap?

Medigap may be the right choice if you:

• Want the freedom to see any Medicare-accepting doctor without referrals
• Have complex health needs or see multiple specialists regularly
• Travel frequently and want nationwide coverage
• Prefer predictable, consistent healthcare costs with minimal surprises
• Want to access major academic medical centers or out-of-network specialists
• Are willing to pay a higher monthly premium for comprehensive coverage

Can You Switch Between Medicare Advantage and Medigap?

This is one of the most important things to understand before you make your initial Medicare enrollment decision:

• Switching from Medigap to Medicare Advantage is generally easy — you can do this during the Annual Enrollment Period each year
• Switching from Medicare Advantage back to Medigap is more difficult — in most states, you will need to pass medical underwriting, meaning insurance companies can deny your application or charge higher premiums based on your health history
• Exception: New York and Connecticut have guaranteed issue protections that allow residents to switch between plans more freely, which is an important advantage for New York seniors

This asymmetry means your initial Medicare enrollment decision is extremely important, especially if you live outside of New York or Connecticut. Getting it right the first time is critical.

Frequently Asked Questions

Is Medicare Advantage or Medigap better?

Neither is universally better; the right choice depends on your health needs, budget, preferred doctors, and lifestyle. An independent Medicare broker can help you compare both options side by side based on your specific situation.

Can I have both Medicare Advantage and Medigap?

No, you cannot use a Medigap plan with a Medicare Advantage plan. Medigap is designed to supplement Original Medicare only.

Does Medigap cover prescription drugs?

No — Medigap plans do not include prescription drug coverage. If you choose Medigap, you will need to enroll in a separate Medicare Part D plan for drug coverage.

Can I switch from Medicare Advantage to Medigap in New York?

Yes — New York has guaranteed issue protections that allow residents to switch from Medicare Advantage to Medigap without medical underwriting. This is a significant advantage for New York seniors compared to most other states.

Get Expert Help Choosing Between Medicare Advantage and Medigap

Choosing between Medicare Advantage and Medigap is one of the most important healthcare decisions you will make in retirement. As an independent Medicare broker, I compare plans from all major carriers with no bias toward any single company to help you find the plan that fits your specific situation.

I serve clients across New York, New Jersey, and nationwide by phone, video, or in person — completely free of charge.

📞 Contact Craig Smith Insurance Group today at (917) 740-1895 for your free Medicare consultation. No pressure, no obligation — just straightforward guidance from an independent broker who genuinely cares about getting you the right coverage.