What Is the Difference Between Medicare Advantage and Medigap?

If you're 65 or about to turn 65, you may be wondering: Is regular Medicare enough for my needs? Do I need supplemental insurance?

Medicare Parts A and B, also known as original Medicare, provide good basic health coverage. But they don’t cover everything. 

Medicare Advantage (Part C) is an alternative way to receive your Medicare benefits through a private insurance plan. Medigap supplements original Medicare by helping to pay your share of covered health care costs—like deductibles, coinsurance, and copayments. Roughly 54% of Medicare beneficiaries are enrolled in a Medicare Advantage plan. And 87% of traditional Medicare enrollees have some form of supplemental coverage.¹

Medicare Advantage and Medigap are two ways to fill Medicare coverage gaps and control your costs. You can't sign up for both types of coverage at once. That's why it's important to know how these plans work, the differences between the two, and the pros and cons of each.

Note: You can't use Medigap to pay Medicare Advantage out-of-pocket costs.

What is Medicare Advantage?

Medicare Advantage, also known as Part C, is a way for older adults to receive original Medicare coverage from private health plans instead of directly from the government. The most common types of Medicare Advantage plans are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-For-Service (PFFS) plans. To join a Medicare Advantage plan, you must be enrolled in Medicare Parts A and B. 

Medicare Advantage plans must cover the same services offered under original Medicare, but they may also bundle that coverage with additional services original Medicare doesn't cover. Most Medicare Advantage plans also include coverage for prescription drugs (Part D). These plans require cost sharing in addition to monthly premiums, typically in the form of copayments and/or deductibles.

What are the pros of Medicare Advantage?

1. There’s a cap on out-of-pocket costs: With original Medicare, there’s no limit on what you spend out of your own pocket. That means a single extended hospital stay could become an enormous financial burden. But Medicare Advantage plans put a limit on how much you’ll have to spend. In 2026, the Part C out-of-pocket maximum is $9,250; this amount will increase to $9,850 in 2027. Individual Medicare Advantage plans can set lower limits if they wish. 
   
   Once you reach the out-of-pocket limit, your plan pays 100% of covered health services for the rest of the calendar year. If your income is limited and you value predictability, a cap on out-of-pocket costs can give you peace of mind.
2. You may be able to get coverages not provided by original Medicare: Medicare Advantage plans cover hospital services and doctor visits just like original Medicare. But they may also provide benefits not included with regular Medicare, such as vision, hearing, dental, fitness classes, and medically necessary transportation. Select plans also offer non-medical benefits like assistance with utility bills and pre-paid debit cards to purchase healthy foods. Be sure to check with any plan you're considering to understand the additional coverages provided.
3. All your coverages are rolled into one plan: Many Medicare Advantage plans offer the convenience of having your hospital, medical, and prescription drug coverage combined into a single plan. This means you won’t have to purchase a standalone Part D plan and pay a separate monthly premium (estimated at about $35.09/mo. in 2026, on average, projected to increase to $36.00 in 2027).
4. Your premiums may be lower: Medicare Advantage plans generally offer low monthly premiums (in addition to your Part B premium) or no-premium plans. This may cost you less per month than having original Medicare, Part D, and a Medigap policy. For 2026, the average Medicare Advantage plan premium is estimated at $14.00 per month, projected to drop to $12.00 in 2027. This may appeal to you if you like having lower up-front costs.
5. You have options if you're not happy with your plan: Each year, you have two opportunities to change back to original Medicare or switch Medicare Advantage plans. These are the Medicare Annual Open Enrollment Period (Oct. 15-Dec. 7) and the Medicare Advantage Open Enrollment Period (Jan. 1-March 31).

What are the cons of Medicare Advantage?

1. You may be restricted in what providers you see: Original Medicare allows you to see any health care provider that accepts Medicare. But Medicare Advantage plans typically don’t give you that freedom of choice. Many of these private plans have a designated network of providers restricted to a member’s geographic area. Except for emergencies, some plans may not cover care outside of their defined service area—or they may impose higher cost sharing or prior authorization rules for out-of-network care.
   
   This limited access means you might not be able to see the best (or your preferred) providers when you have a need. It may also be challenging to find providers if you live in a rural area.
   
   What's more, with Medicare Advantage, you may have to get a referral from your primary care provider if you want to see a specialist. This extra visit translates into extra time and expense.
2. You could end up paying more out of pocket. While the low monthly premiums of Medicare Advantage plans may be alluring, you risk paying more in the long run in the form of co-payments, deductibles, and other out-of-pocket costs. If you develop a serious illness or chronic condition, these costs can pile up quickly (and exceed what you’d pay with original Medicare).
   
   Medigap plans, on the other hand, are more likely to offer predictable out-of-pocket costs. A Medigap plan may cover all the remaining costs after Medicare pays its share, depending on the type of plan you have. Also, in a report on Medicare, KFF found that people with original Medicare plus supplemental coverage reported fewer cost-related problems than Medicare Advantage enrollees. Those without supplemental coverage reported more.²

One important distinction between Medicare Advantage and original Medicare is that with Medicare Advantage, plan availability, costs, drug formularies, provider networks, and coverages can change every year. These changes are outlined in the Annual Notice of Change (ANOC) sent out to plan members every September. Learn more about the ANOC.

For the 2027 coverage year, many plans are implementing changes that can affect the total cost of care, access to doctors and hospitals, prescription drug coverage, and availability of benefits that help older adults live independently. Changes include reductions or elimination of extra benefits and higher cost-sharing amounts. Some plans are being discontinued or capping enrollments. 

It’s important to understand how these changes might affect your own health care, budget, and access to services. If your plan no longer fits your needs, explore your coverage options during Medicare Annual Open Enrollment or the Medicare Advantage Open Enrollment period. You have choices. 

What is Medigap and how does it work with Medicare and Medicare Advantage?

Medigap is additional insurance that can be purchased from private insurance carriers in each state. While Medicare Advantage is an alternative way to get your Medicare benefits, Medigap is purely supplemental. Its purpose is to bridge the “gaps” in your original Medicare coverage. You cannot use Medigap with a Medicare Advantage plan. 

A Medigap plan is designed to reimburse you for the costs you pay out of your own pocket, such as deductibles, copayments, coinsurance, and more. The amount of reimbursement you receive depends on the type of plan you have. 

Based on where you live, you can choose from up to 10 different Medigap plans: A, B, C, D, F, G, K, L, M, and N (Medigap plans in Wisconsin, Massachusetts, and Minnesota are named differently). Each type of Medigap plan provides a unique set of benefits. Note: Plans C and F are no longer available to people who first joined Medicare on or after Jan. 1, 2020. These plans are still in place for people who enrolled prior to that date.

It’s important to note that Medigap is an optional insurance policy. If you buy one, you must pay a monthly premium in addition to the monthly Part B premium you pay to Medicare.

What are the pros of Medigap?

1. It can help make your out-of-pocket costs more predictable and affordable: Since Medigap provides reimbursement for some or all of your Medicare Part A and Part B copayments and deductibles (depending on your plan), you don’t have to worry about cost every time you visit a doctor or hospital. Most Medigap plans cover the Medicare Part A hospital deductible, which is $1,736 in 2026 (projected to increase to $1,788 in 2027 according to the 2026 Medicare Trustees Report). Should you experience a health emergency or extended hospital stay, Medigap coverage can save you a significant sum.
2. You may be able to get coverages not provided by Original Medicare: For example, standard Medigap plans C, D, F, G, M, and N provide emergency health coverage when you take a trip outside the U.S. This is a valuable benefit if you travel abroad frequently. A small number of Medigap plans also offer other nontraditional benefits such as dental, vision, and hearing.

What are the cons of Medigap?

1. It can be expensive: Medigap premiums vary greatly, ranging from as little as $30 to $40 per month all the way up to $400 or more per month. In 2025, the average monthly premium for a Medigap policy was $244).³ Generally, you can expect to pay less for Medigap plans with less coverage. Some plans also have cost sharing in addition to premiums.
2. Prescription drugs are not covered: Medigap policies do not cover prescription drugs, so you must enroll in and pay for a separate Medicare Part D plan.
3. It’s not easy to switch plans: The best time to buy a Medigap policy is during your six-month Medigap Open Enrollment Period. This period automatically begins the first month you have Medicare Part B and you're age 65 or older. Once this enrollment period is over, you may pay more for a Medigap policy—or you may be denied coverage outright—if you don’t meet the carrier’s medical underwriting guidelines. Note: If you live in Connecticut, Massachusetts, Maine, or New York, you may be able to buy a Medigap policy beyond your enrollment period without answering underwriting health questions.

Get help navigating your Medicare options

Comparing different Medicare plans and deciding on the right one for you can feel overwhelming, but help is available. Get free, unbiased Medicare guidance from your local State Health Insurance Assistance Programs (SHIP). SHIPs are offered in all U.S. states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. Find local Medicare help today.

Sources

1. KFF. A Snapshot of Sources of Coverage Among Medicare Beneficiaries. December 29, 2025. Found on the internet athttps://www.kff.org/medicare/a-snapshot-of-sources-of-coverage-among-medicare-beneficiaries/

2. Nancy Ochieng and Jeannie Fuglesten Binek. Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature. Kaiser Family Foundation. Sept. 16, 2022. Found on the internet at https://www.kff.org/medicare/report/beneficiary-experience-affordability-utilization-and-quality-in-medicare-advantage-and-traditional-medicare-a-review-of-the-literature/

3. KFF. Key Facts About Medigap Enrollment and Premiums for Medicare Beneficiaries. October 13, 2026. Found on the internet at https://www.kff.org/medicare/key-facts-about-medigap-enrollment-and-premiums-for-medicare-beneficiaries/