Medicare Advantage vs. Medigap
Two different ways to build your coverage, side by side in plain English, with every fact linked to Medicare.gov.
Chris Frasca Insurance Services · California Insurance License No. 0L86243
Last updated October 5, 2026. Facts come from Medicare.gov and CMS and are linked in the sources below.
The short version: Once you have Part A and Part B, there are two main ways to get the rest of your coverage. You can stay with Original Medicare and add a Medigap policy and a separate drug plan, or you can choose a Medicare Advantage plan that bundles your coverage. You can't have Medigap with a Medicare Advantage plan. Neither is better for everyone, so the right one depends on your doctors, your health, and your budget.
The two paths
- Original Medicare, plus Medigap and a drug plan (optional). You keep Original Medicare, and you can add a Medigap (Medicare Supplement) policy from a private company to help pay costs Medicare doesn't, such as your 20% coinsurance. You join a separate Medicare drug plan for prescriptions.
- Medicare Advantage. A private plan that replaces how you get your Medicare coverage. You still pay your Part B premium, and most plans include drug coverage.
Side by side
Any doctor or hospital that takes Medicare, anywhere in the U.S.
You may need to use providers in the plan's network.
In most cases you don't need a referral.
You may need a referral to see a specialist.
No yearly limit, unless you have supplemental coverage such as Medigap or other insurance.
Plans have a yearly limit on what you pay for covered Medicare services.
You join a separate Medicare drug plan.
Most plans include drug coverage, so you don't need a separate plan.
Doesn't cover routine exams or most dental care.
Plans may offer extras Original Medicare doesn't cover, like some vision, hearing, and dental services.
Generally not covered.
Plans generally don't cover medical care outside the U.S.
You pay the Part B premium, plus the premium for any Medigap or drug plan you add.
You pay the Part B premium and may also pay the plan's premium.
You can choose to buy a Medigap policy to help pay costs Medicare doesn't cover, like your 20% coinsurance.
You can't buy Medigap to cover your out-of-pocket costs.
Source: Medicare.gov, Compare Original Medicare & Medicare Advantage. The table uses the page's wording, shortened.
Questions to ask yourself
- Are your doctors and hospital in the plan's network? If you want to keep seeing any provider that takes Medicare, that points one way. If your doctors are in a plan's network, that changes the picture.
- How do you like to pay for care? Some people prefer a higher monthly premium for fewer surprises. Others prefer a lower monthly premium and pay more when they use care. Look at both the monthly cost and what you would pay if you needed a lot of care.
- Do the extras matter to you? Some Medicare Advantage plans offer vision, hearing, and dental services that Original Medicare doesn't cover.
- How much do you travel? Medicare.gov says neither path generally covers medical care outside the U.S.
- What drugs do you take? Check that your medications and pharmacy are covered under any drug plan, whether it is separate or part of a Medicare Advantage plan.
Timing matters for Medigap
Your one-time Medigap enrollment window lasts 6 months and starts the first month you are 65 or older and signed up for Part B. After that period, Medicare.gov says your options to buy a Medigap policy may be limited and the policy may cost more. If you are turning 65, read the turning-65 guide.
Source: Medicare.gov, When can I buy a Medigap policy?
You can review your choice each year
People with Medicare can review their coverage and make changes during Annual Enrollment, October 15 through December 7. Changes take effect January 1. See what CMS has published for 2027 in California.
Source: CMS, 2027 Medicare Advantage and Part D landscape, California fact sheet.
Common questions
Can I have both a Medigap policy and a Medicare Advantage plan?
No. If you're on Medicare Advantage, you can't buy Medigap to cover your out-of-pocket costs. Medigap only works with Original Medicare.
Which one lets me see any doctor?
Original Medicare. You can see any doctor or hospital that takes Medicare, anywhere in the U.S. With Medicare Advantage you may need to stay in the plan's network. Medigap goes on top of Original Medicare, so it doesn't add a network.
Do I need a separate drug plan?
With Original Medicare, yes. You join a separate Medicare drug plan (Part D). Most Medicare Advantage plans already include drug coverage, so you don't need a separate one.
Is there a limit on what I pay in a year?
Medicare Advantage plans have a yearly limit on what you pay for covered Medicare services. Original Medicare doesn't have one, unless you add supplemental coverage like Medigap or you have other insurance.
Can I change my mind later?
Yes. Every year from October 15 through December 7 you can review your coverage and make changes, and they start January 1. If you decide you want a Medigap policy later, keep in mind your options may be limited and it may cost more once your one-time Medigap enrollment window is over.
What does it cost to work with you?
Nothing. The insurance company pays me a commission, not you, so your premium is the same whether you enroll through me or directly with Medicare. There's no fee for a consultation, a plan review, or the yearly check-in.
Want help sorting it out?
I'll look at your doctors, medications, and budget with you, at no cost and with no pressure. I review the plans I represent, which is a limited number of insurance organizations. I meet clients in person in Orange County and by phone or video in Orange County and Ventura County.
Sources
- Medicare.gov, Compare Original Medicare & Medicare Advantage
- Medicare.gov, When can I buy a Medigap policy?
- CMS, 2027 Medicare Advantage and Part D landscape, California fact sheet
This page is for education and is not connected with or endorsed by the United States government or the federal Medicare program. Plan details vary, so check each plan's own materials. I am a licensed insurance agent and do not offer every plan available in your area; see the disclaimer below.