When you turn 65 or qualify for Medicare due to a disability, you face a big choice: stick with Original Medicare and add a Medigap plan, or switch to a Medicare Advantage (Part C) plan. Each path has unique costs, benefits, and enrollment rules. Here’s a clear, jargon-free guide to help you decide.
How the Options Work
Original Medicare + Medigap
Original Medicare = Part A (hospital) + Part B (medical) coverage. You add a Medigap policy (sold by private insurers) to cover your deductibles, copays, and coinsurance. You may also buy a separate Part D drug plan.
Medicare Advantage (Part C)
A private-insurer plan that replaces Original Medicare, bundling Part A, Part B, and usually Part D drug coverage. Often includes extra benefits (dental, vision, hearing, fitness). You still pay the standard Part B premium to Medicare.
Visual comparison of Medicare coverage options: Original Medicare + Medigap vs Medicare Advantage
Monthly Costs Comparison
Understanding the cost differences helps you budget effectively for your healthcare needs.
| Coverage Option | 2025 Average Premiums |
| Part B Premium (all plans) | $185/month |
| Medicare Advantage Premium (MA-PD) | $17/month (avg.) |
| Medigap Plan Premiums | $65–$450/month depending on plan type (e.g., Plan G) and location |
Key Takeaways
· MA plans often have very low or $0 premiums beyond Part B
· Medigap plans can be 4–10× more expensive but cover nearly all out-of-pocket costs
Monthly premium comparison between Medicare Advantage and Medigap plans
Coverage and Out-of-Pocket Protection
| Feature | Medicare Advantage | Original + Medigap |
| Out-of-Pocket Limit (Parts A&B) | $9,350 in-network / $14,000 combined (max) in 2025 | None—Medigap covers deductibles & coinsurance |
| Deductibles & Copays | Plan-specific; often $0–$500 annual deductibles | Covered by Medigap (Plan G covers all Part A/B gaps) |
| Provider Choice | Must use network providers; referrals often required | Any provider accepting Medicare; no referrals needed |
| Extra Benefits | Vision, dental, hearing, fitness, OTC allowances | No extra benefits—only Original Medicare services |
| Travel Coverage | Emergency only outside service area | Covered nationwide wherever Medicare is accepted |
Enrollment Periods and Timing
Initial Enrollment Period (IEP)
Starts 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after. Join MA or original + Medigap; if you miss IEP, you may face late-enrollment penalties.
Annual Open Enrollment (Oct 15–Dec 7)
Switch MA plans or drop MA for original Medicare+Part D. New coverage starts Jan 1.
Medicare Advantage Open Enrollment (Jan 1–Mar 31)
If you have MA, you can switch to another MA or revert to original Medicare (no Medigap purchase guaranteed).
Guaranteed Issue Rights (Medigap SEP)
Lose MA coverage involuntarily or move out of plan area → you can buy Medigap without health underwriting within 63 days.
Provider Networks and Geographic Coverage
One of the biggest differences between these options is where and how you can receive care.
Medicare Advantage plans restrict you to their network of doctors and hospitals. Going out-of-network often means higher costs or no coverage at all. This works well if you stay in one area but can be limiting if you travel frequently.
Original Medicare with Medigap gives you freedom to see any doctor who accepts Medicare[12][8]. There are no network restrictions, referrals, or geographic limitations. You can receive care anywhere in the United States.
Geographic coverage differences between Medicare Advantage and Original Medicare with Medigap
Pros and Cons at a Glance
Medicare Advantage
Advantages:
· Low or $0 premiums beyond Part B
· Bundled benefits (Part A, B, D) plus extras (dental, vision, gym)
· Annual out-of-pocket limit protects against catastrophic costs
Disadvantages:
· Restricted network; out-of-network care may cost more
· Prior authorizations can delay non-emergency care
· Travel restrictions—coverage outside plan area limited
Medigap + Original Medicare
Advantages:
· Freedom to see any doctor accepting Medicare
· No copays or deductibles for covered services (Plan G)
· Nationwide coverage—no geographic limits
Disadvantages:
· Higher monthly premiums (up to $450/month)
· Separate Part D plan needed for prescriptions
· No extra benefits like dental or fitness
Who Should Choose Which Option?
Choose Medicare Advantage if you:
· Want predictable, low monthly premiums
· Value extra benefits (vision, dental, gym)
· Prefer an annual cap on your out-of-pocket costs
· Stay in one geographic area most of the time
Choose Medigap + Original Medicare if you:
· Travel frequently or have a second home out of state
· Want unrestricted provider access and no referrals
· Can afford higher premiums to avoid copays and deductibles
· Value the flexibility to see any Medicare-accepting provider
Real-Life Client Story
Michelle from Okeechobee, Florida, faced this exact decision when she moved from Alabama. At first, she was concerned about finding new doctors and transferring her prescriptions. We helped her evaluate both options.
“I had lived in Alabama 25 years and had concerns about what I would get,” Michelle shared. “When I made all that information known to you, you gave me the different programs to look at what would be best for me.”
Michelle chose a Medicare Advantage plan with Humana that included prescription drug coverage. The plan helped her locate new doctors in her area and handled all her prescription transfers seamlessly.
“It’s been going very well because I was able to locate a doctor because actually Humana gives you a reference to a doctor in your area,” she explained. “They were able to handle all that and there was no problem with my insurance. I never had any kick-ups that would have stopped me from getting the medical care I needed.”
For Michelle, the Medicare Advantage plan’s network support and coordinated care made her transition to Florida stress-free and affordable.
Next Step: Get Personalized Guidance
Review your health needs and budget. Then:
1. Visit HealthCare.gov or your state exchange
2. Compare MA plans’ networks, benefits, and premiums
3. Get Medigap quotes for Plan G in your area
4. Call us at (786) 730-9658 or email support@simplestartinsurance.com for a free, personalized plan comparison
