Medigap vs. Medicare Advantage: Which Should You Choose?

Over half of Medicare beneficiaries enroll in Medicare Advantage, the private insurance alternative to Original Medicare

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Centers for Medicare & Medicaid Services. Medicare Monthly Enrollment. Accessed Oct 6, 2026. View all sources . It’s not hard to see why: 67% of Medicare Advantage plans with prescription drug coverage come with a $0 premium, according to KFF, a health policy nonprofit

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KFF. Medicare Advantage 2026 Spotlight. Accessed Oct 6, 2026. View all sources . And they often cover stuff that Medicare doesn’t — like some dental, vision and hearing.

Here’s the catch: Medicare Advantage can be more expensive if you get sick. These plans often come with relatively high copays and coinsurance. You may not be covered at all if you go out-of-network or don’t get prior approval for certain services. On the other hand, Original Medicare with Medigap — also known as Medicare Supplement Insurance — covers most of these costs and allows you to see any provider who accepts Medicare. But it generally costs more per month.

You can’t have Medigap and Medicare Advantage at the same time. And choosing between the two is complicated by the fact that you might not be able to change your mind later on.

You can’t predict your future health, but you can make an informed decision. Our comparison focuses on the two most important factors: cost and access to care. Here’s how to weigh them against your finances, health and risk tolerance.

Medigap vs. Medicare Advantage

Medigap vs. Medicare Advantage quiz: Which one is right for you?

Wondering whether Medicare Advantage is worth the risk, or Medigap is worth the money? Take our quiz below to find out which one might be a better fit for you.

The quiz gives you a starting point, and our analysis below explains the reasoning. Here are the trade-offs between Medigap and Medicare Advantage and some catches to be aware of.

Cost: Medicare Advantage is often cheaper — until you get sick

In general, Medicare Advantage costs less upfront and potentially more overall if you need lots of medical care. Medigap plans have higher upfront costs but cover most if not all of your expenses when you need care.

Whichever you choose, you’ll still have to pay your Medicare Part B premium ($202.90 per month in 2026) on top of the costs listed below.

Medigap costs

• Premiums: Anywhere from $30 to $40 per month up to $300 or more per month, and premiums may go up as you age. If you enroll in Medigap Plan G, the most popular Medigap plan type, premiums start at $145 per month for a 65-year-old nonsmoking female in Atlanta, a metro area with average Medigap costs

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  Medicare.gov. Find a Medigap policy that works for you. Accessed Oct 6, 2026. View all sources . You’ll also need a standalone Medicare Part D plan if you want prescription drug coverage, which has an average monthly premium of $34.50 in 2026.

• Cost of care: For care covered by Medicare, your out-of-pocket costs will be minimal. If you opt for Medigap Plan G, you won't pay much more than your Medicare Part B deductible, which is $283 in 2026.

Medicare Advantage costs

• Premiums: The average Medicare Advantage premium is $14 per month in 2026, and most plans have a $0 premium

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  KFF. Medicare Advantage 2026 Spotlight. Accessed Oct 5, 2026. View all sources . Plus, your prescription drug coverage is usually included. 

• Cost of care: Includes deductibles, copays and coinsurance up to your plan’s out-of-pocket maximum. This can be as high as $9,250 in 2026, though the average plan caps your costs at $6,120 for in-network care. Out-of-network care usually costs more.

What you might pay in a healthy year

Let’s say you have a relatively healthy year and don’t need a lot of care. You go to your annual wellness visit, two routine primary care visits and two specialist visits. You don’t need any procedures, exams, hospital stays or emergency room visits this year.

Below we compare what your overall health care costs might look like between Medicare Advantage and Medigap. We assume you go with the popular Medigap Plan G, one of the more comprehensive but expensive Medigap plans. This comparison doesn’t include prescription drug costs.

*Doesn’t include the Part B premium or prescription drug costs. Both paths are subject to the same Part B premium and annual cap on prescription drug costs.

» MORE: Best Medicare Advantage plans

What you might pay in a sick year

Now let’s look at a year in which you have a serious medical event. Say you need extensive care — surgery, an inpatient hospital stay, specialist and follow-up appointments and rehabilitation.

Below we compare what your overall health care costs might look like. In this situation, we assume this combination of care generates enough in medical costs to surpass your Medicare Advantage plan’s out-of-pocket limit, so you’d only pay up to your plan’s limit. This assumes all the care you receive is covered and in-network.

*Doesn’t include the Part B premium or prescription drug costs. Both paths are subject to the same Part B premium and annual cap on prescription drug costs.

» MORE: Best Medigap Plan G companies

Access: Medigap makes it easier to get the care you need

It doesn’t matter how affordable your insurance is if it fails to cover you when you need it most. Nearly 20% of people leave their Medicare Advantage plans because of problems with their networks, and 15% say it’s because of difficulty getting care. That’s according to NerdWallet analysis of disenrollment data from the Centers for Medicare & Medicaid Services

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NerdWallet analysis of CMS data. Star Ratings Data Tables - Disenrollment Reasons. Accessed Oct 9, 2026. View all sources .

Here’s how Medigap and Medicare Advantage compare when it comes to accessing care.

Networks

With Original Medicare, you can see any provider in the country that accepts Medicare — and almost all do. This often makes it a better option for people who live in rural areas or retirees who have multiple places they call home.

Medicare Advantage plans are similar to employer-provided group health insurance: To be covered, you typically must choose health care providers in the insurance company’s network. If you go out-of-network, your costs may not be covered or may not apply to your out-of-pocket limits. Even if your doctor is in-network now, that could change and you might not get much notice.

The average Medicare Advantage member has access to less than half (48%) of local doctors available to people with Original Medicare, according to KFF. The network may be relatively narrow if the plan is a health maintenance organization (HMO) or somewhat broader if it’s a preferred provider organization (PPO).

Referrals and prior authorization

Networks aren’t the only hurdle to accessing care with Medicare Advantage. With Original Medicare, you usually don’t need a referral to see a specialist. You can get the care you need without prior authorization as long as it’s medically necessary and covered by Medicare.

With Medicare Advantage, you often need referrals to see specialists. You may also need to get approval for certain types of care — 99% of Medicare Advantage members have to get prior authorizations for at least some services, according to KFF. The most common services that require prior authorization are inpatient hospital stays, skilled nursing facility stays and chemotherapy. Prior authorization requests can also be denied, which may lead to a lengthy appeals process, a lot of paperwork and delays in medical care.

Travel and moving

Medicare Advantage plans are typically regional. If you move out of the area or travel to other states, you may not be covered. Since Original Medicare lets you see any provider who accepts Medicare, it’s generally easy to find care anywhere in the U.S.

Many Medigap plans also include 80% coverage for foreign travel emergencies, up to plan limits. Medicare Advantage plans usually don’t cover medical care outside of the U.S., aside from some emergency coverage on plans with travel benefits.

Medicare Advantage comes with extras, but they might not be worth it

Medicare Advantage plans often tout extra benefits that don’t come with Original Medicare or Medigap. In recent years, plans have made notable cuts to perks like over-the-counter allowances, meals and transportation. However, 98% of Medicare Advantage plans still offer some dental, vision and hearing coverage

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KFF. Medicare Advantage 2026 Spotlight. Accessed Oct 6, 2026. View all sources .

Dental work is expensive, so this coverage might seem valuable. But it often doesn’t cover much. Some plans only cover your annual exams and cleanings, which aren’t very expensive to begin with, and only at your plan network’s dentists. Even plans that cover more usually only pay for a percentage of your dental work up to a fairly low annual limit, typically around $1,000 to $2,000. And you might need prior authorization.

Don’t let these supplemental benefits drive your decision between Medigap and Medicare Advantage. Focus on what you’ll pay if you get sick and how easily you can access the care you need. If you’re comparing two plans with the same core coverage, then you can look to the perks as a differentiator.

Why you might not be able to change your mind

You might be tempted to choose Medicare Advantage’s low premiums if you’re 65 and relatively healthy. But the choice isn’t just for your current self. It’s also for the person you’ll be at 75 or 85, when you’re more likely to have serious health issues.

While you get a chance to join or switch Medicare Advantage plans each year, you may only get one Medigap open enrollment period. After that, insurers can turn you down or charge you more based on your health. So you can always leave Medigap and switch to Medicare Advantage, but the opposite might not be possible.

The two paths also have different long-term risks. With Medigap, your coverage shouldn’t change — the main risk is that your premium rises as you age. With Medicare Advantage, your plan’s copays, benefits and provider network can change at any time. Your plan could even leave your county entirely, forcing you to find new coverage.

When to buy Medicare Advantage

Medicare-eligible people can buy Medicare Advantage during their initial enrollment period. This is typically your 65th birthday month, plus the three months before and after. After that, you can change plans during two enrollment periods:

• Medicare open enrollment, which happens from Oct. 15 to Dec. 7 each year.

• Medicare Advantage open enrollment, which occurs from Jan. 1 to March 31 each year. 

You may also be able to switch plans if you qualify for a special enrollment period. These are triggered by certain life changes, like a move out of your plan's service area or into a skilled nursing facility.

When to buy Medigap

You can buy Medigap during your one-time Medigap open enrollment period. This is the six-month period that starts the month you're 65 or older and have Medicare Part B. During this time, companies must offer you a Medigap plan at the same price as everyone else.

After this period, you may have to go through medical underwriting to get a policy. This could result in a higher price or denial of coverage if you're in poor health. This is true unless you live in Connecticut, Massachusetts, Maine or New York. These states offer guaranteed issue protections.