Medicare Advantage vs. Medigap: The Plain-English Comparison

Every fall, millions of people sit down with a stack of Medicare mail and try to answer one question: Medicare Advantage or Medigap? It is the biggest fork in the road in all of Medicare, and most people never had it explained by someone without a plan to sell.

This article is that explanation. No winner gets declared here, because there isn’t one. There is only the option that fits your health, your budget style, and your life. With Medicare open enrollment running October 15 through December 7, this is the right moment to understand both paths clearly.

The one-sentence version of each

Medicare Advantage: a private plan that takes over delivering your Medicare benefits, usually bundles drug coverage and some extras, usually uses a provider network, and typically charges a low or zero monthly premium in exchange for copays and coinsurance as you use care.

Medigap (also called Medicare Supplement): a private policy that rides alongside Original Medicare and pays most of what Medicare doesn’t, in exchange for a meaningful monthly premium and very few surprises later.

Put even more simply, Medicare Advantage tends to mean lower fixed costs and variable bills. Medigap tends to mean higher fixed costs and predictable bills. Almost everything else flows from that trade.

Both are mainstream choices. In 2026, about 55% of eligible Medicare beneficiaries are in Medicare Advantage, according to KFF. Among people who stay with Original Medicare, roughly four in ten carry a Medigap policy.

Costs, compared honestly

Start with what everyone pays. The standard Part B premium is $202.90 per month in 2026, and you keep paying it no matter which path you choose. The Part B annual deductible is $283.

On top of that, here is how the two paths differ.

Medicare Advantage keeps the monthly outlay low. The average plan premium is about $14 per month in 2026, and roughly three quarters of enrollees in plans with drug coverage pay no plan premium at all. The trade-off shows up when you use care. You pay copays and coinsurance for visits, tests, and hospital stays until you hit your plan’s annual in-network out-of-pocket maximum. Federal rules cap that limit at $9,250 for in-network care in 2026, though the average plan sets it around $5,400. In a healthy year you might spend very little. In a hard year you could spend thousands.

Medigap flips the math. A popular Plan G policy typically runs somewhere between about $140 and $250 per month for a new 65-year-old, and prices vary a lot by state, age, gender, tobacco use, and insurer. In exchange, after you meet the $283 Part B deductible, Plan G pays essentially all of your remaining Medicare-approved medical costs. You will also need a separate Part D drug plan with its own premium. Your monthly total is higher, but a bad health year barely moves it.

Neither structure is cheaper for everyone. A person who rarely sees a doctor may come out ahead on Medicare Advantage for years. A person managing several conditions may find the Medigap premium is the cheaper total once all the copays are counted. Be honest with yourself about which person you are, and which person you might become.

Doctors and networks

This is the difference people feel most in daily life.

Medicare Advantage plans generally use networks, most often HMOs or PPOs. You pick from the plan’s doctors and hospitals, you may need referrals for specialists, and some services require the plan’s approval in advance (prior authorization). Networks can also change from year to year, so a doctor who is in-network today is not guaranteed to stay that way.

With Original Medicare plus Medigap, there is no network. You can see any doctor or hospital in the country that accepts Medicare, which the large majority do, with no referrals. If you split time between two states, travel often, or want to reach a particular specialty center without asking permission, that flexibility is the core of what the Medigap premium buys.

The extras question

Medicare Advantage plans often advertise benefits Original Medicare does not cover: dental, vision, hearing, gym memberships, over-the-counter allowances, sometimes transportation. These are real, and for some people genuinely useful. Just read the details before counting on them. Allowances have caps, extra benefits often have their own networks, and plans can trim or reshape them every January.

Medigap includes no extras at all. Its only product is predictability. People on that path typically buy standalone dental or vision coverage if they want it, or simply pay cash for cleanings and glasses.

A fair way to weigh this: extras are a bonus, not a foundation. Compare the two paths on medical coverage first, then let the extras break a tie.

How prescription drugs fit in

Most Medicare Advantage plans include Part D drug coverage in the bundle. Medigap never covers drugs, so people on that path pair it with a standalone Part D plan.

The good news is that the drug benefit itself now works the same either way. In 2026, no plan’s drug deductible can exceed $615, and once your out-of-pocket drug spending reaches $2,100, you pay nothing more for covered drugs the rest of the year. That cap applies whether your coverage comes bundled in an Advantage plan or from a standalone plan. For the 2027 plans you are shopping this fall, CMS has set the maximum drug deductible at $700 and the out-of-pocket cap at $2,400.

One caution for the Medigap path: skipping Part D because you take no medications now can trigger a permanent late enrollment penalty later. Even a low-premium plan keeps you penalty-free.

The switching-back trap

Here is the part that too few people hear before they choose, and it is the reason your first decision matters more than it appears.

You can move from Medicare Advantage back to Original Medicare during enrollment periods any year. But buying a Medigap policy is a separate step, and outside of certain protected windows, insurers in most states can use medical underwriting. That means they can review your health history and charge you more, or decline you entirely, because of conditions you developed along the way.

The main protected windows are worth knowing by name. When you first enroll in Part B at 65, you get a six-month Medigap open enrollment period during which no insurer can turn you down. And if you try Medicare Advantage for the first time, federal trial rights generally let you switch back and buy a Medigap policy without underwriting within your first 12 months.

Some states go further. New York and Connecticut require insurers to accept Medigap applicants year-round without underwriting, and Maine and Massachusetts have their own broader protections. Roughly 16 states now have “birthday rules” that allow existing Medigap holders an annual window to switch policies without health questions, a list that grew again in 2026. These rules vary and change, so check what applies where you live before assuming anything.

The plain-English takeaway: moving from Medigap to Medicare Advantage is easy at any age. Moving the other direction, years later and in most states, may depend on your health at that moment. Whichever way you lean, decide as if the door behind you might narrow.

Who tends to fit which

Traits, not verdicts. See which column sounds more like you.

People who tend to be comfortable in Medicare Advantage often stay close to home most of the year, have doctors already in a plan’s network, are in reasonably good health and fine with paying as they go, prefer the lowest possible monthly bill, and like having dental or vision folded in.

People who tend to be comfortable with Medigap often travel or live in two places, want the freedom to see any Medicare doctor without referrals, are managing conditions that mean frequent appointments, prefer a fixed monthly cost over variable bills, and can absorb the premium without strain.

If you sit somewhere in the middle, that is normal. This is exactly the situation the free help below exists for.

Free help that isn’t selling anything

Two resources give unbiased, personal answers at no cost. Your State Health Insurance Assistance Program (SHIP) offers free one-on-one counseling from trained volunteers who earn nothing from your choice; find yours at shiphelp.org or by calling 1-877-839-2675. And 1-800-MEDICARE (1-800-633-4227) can walk you through plan comparisons, as can the plan finder at Medicare.gov.

Insurance agents can be helpful too, but they are paid by commission. For a decision this durable, it is worth hearing from someone who isn’t.

While you are reviewing coverage this fall, our insurance perks page rounds up member discounts worth checking in the same sitting.

This article is part of our open enrollment series running through December 7. Subscribe to Retired Perks and the next comparisons will land in your inbox before the deadline does.

Sources

• CMS: 2026 Medicare Parts A & B Premiums and Deductibles
• KFF: Medicare Advantage in 2026: Enrollment Update and Key Trends
• KFF: Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization
• KFF: Key Facts About Medigap Enrollment and Premiums for Medicare Beneficiaries
• KFF: Medigap Enrollment and Consumer Protections Vary Across States
• Medicare.gov: How much does Medicare drug coverage cost?
• State Health Insurance Assistance Program (SHIP)