Medicare Advantage vs. Medigap in 2026
Choosing Medicare coverage is one of the most important financial and healthcare decisions in retirement. I’ve seen people pick a plan based on a TV ad or a friend’s recommendation, only to discover later that their doctors weren’t covered or their out-of-pocket costs were much higher than expected.
The two main paths Medicare Advantage and Medicare Supplement (Medigap) — work very differently. Neither is universally “better,” but the right choice depends on your health needs, risk tolerance, and budget.
Let’s walk through the differences clearly so you can make an informed decision.
How Medicare Advantage and Medigap Differ
Medicare Advantage (Part C) is an alternative way to receive your Medicare benefits through private insurance companies. These plans replace Original Medicare as your primary coverage.
Medigap (Medicare Supplement) works alongside Original Medicare. Medicare pays first, and your supplement helps cover deductibles, coinsurance, and other gaps.
Choosing incorrectly can mean higher costs, network restrictions, or surprise medical bills so understanding the structure matters.
The Gaps in Original Medicare
Original Medicare by itself has meaningful cost exposure.
Part A (hospital coverage):
• 2026 deductible is projected around $1,736 per benefit period
• Days 61–90: about $434 per day
• Lifetime reserve days 91–150: about $868 per day
Long hospital stays can become expensive quickly.
Part B (outpatient care):
• Medicare generally pays 80%
• You pay 20%
• There is no out-of-pocket cap
That unlimited 20% is the reason many people seek supplemental coverage.
How Medigap Plans Work
Medigap plans are standardized nationwide. Benefits are the same regardless of company — only price and service differ.
There are 10 standardized plans. The most common today:
Plan G
• Covers nearly all gaps
• You pay the annual Part B deductible (about $283 in 2026)
• After that, minimal out-of-pocket costs
Plan N
• Lower premium than Plan G
• Up to $20 doctor copay
• Up to $50 ER copay
• Possible excess charges in some states
Medigap does not include prescription drugs, dental, or vision. You need separate coverage for those.
How Medicare Advantage Works
Advantage plans bundle Parts A and B and often include Part D drug coverage.
Many advertise $0 premiums, but you still pay your Part B premium. Care typically involves copays and coinsurance.
Advantages often include extras like:
• Dental
• Vision
• Hearing
• Gym memberships
These perks can be attractive, but the tradeoff is cost-sharing and network rules.
Cost Structure Comparison
Medigap:
• Monthly premiums often range $90–$200+ depending on location and age
• Very predictable costs
• Minimal copays after deductible
Advantage:
• Often low or $0 premiums
• Pay-as-you-go copays
• Annual maximum out-of-pocket typically $3,000–$10,000+
If you have major medical needs, Advantage out-of-pocket costs can add up.
Networks and Flexibility
This is one of the biggest differences.
Medigap:
• See any doctor nationwide who accepts Medicare
• No referrals
• No prior authorizations in most cases
Advantage:
• Usually HMO or PPO networks
• In-network care matters
• Referrals and prior authorizations often required
If you travel frequently or want nationwide flexibility, Medigap offers more freedom.
National vs. Local Coverage
Medigap works anywhere Medicare is accepted nationwide.
Advantage plans are local. Moving states or counties may require switching plans.
Major Medical Centers
Large centers like Mayo Clinic and Cleveland Clinic generally accept Original Medicare with supplements, but may limit acceptance of some Advantage networks.
Always verify with the provider directly.
Stability Over Time
Medigap plans are stable. Benefits don’t change annually.
Advantage plans can change each year premiums, networks, and copays may shift, requiring annual review.
Enrollment Flexibility
Medigap:
• Best time is your 6-month open enrollment window
• Outside that, medical underwriting may apply
Advantage:
• Can switch during annual enrollment
• No underwriting required
Who Each Plan Fits Best
Medigap is often ideal if you:
• Want predictable costs
• See doctors frequently
• Travel often
• Value provider flexibility
• Prefer minimal surprise bills
Advantage may fit if you:
• Are relatively healthy
• Want lower upfront premiums
• Don’t mind networks
• Appreciate bundled extras
The Bottom Line
There’s no universal winner. The best plan aligns with your health needs, budget, and comfort with risk.
Medigap trades higher premiums for predictability and flexibility. Advantage trades lower premiums for cost-sharing and network limits.
The key is choosing based on how you actually use healthcare — not just the premium advertised on TV.
A thoughtful decision now can prevent expensive surprises later.
