Coverage Options
Medicare Advantage vs. Medigap
Two different paths to covering the gaps Original Medicare leaves behind. Neither is universally "better" — the right fit depends on your health, budget, and priorities.
Quick Answer
Medicare Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Medicare Part B covers doctor visits, outpatient services, preventive care, and durable medical equipment. Together, Parts A and B are called Original Medicare.
What Medicare Covers and What It Doesn't
Original Medicare (Parts A and B) covers a lot, but it's not comprehensive. Part A generally covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice care, and some home health care. Part B generally covers doctor visits, outpatient care, preventive services like annual wellness visits and many screenings, and durable medical equipment such as wheelchairs and walkers.
What Original Medicare typically does not cover is just as important to understand: routine dental care (cleanings, fillings, dentures), routine vision care (eye exams for glasses, glasses themselves), routine hearing care (hearing aids and fittings), most long-term custodial care (help with daily activities like bathing and dressing), and outpatient prescription drugs, which require a separate Part D plan. These are the gaps that Medicare Advantage extra benefits or a Medigap policy paired with Part D are built to help address — see the basics of Parts A, B, C, and D for a fuller breakdown of how the four parts fit together.
Medicare Coverage Gaps
Even for the services Original Medicare does cover, you're usually responsible for deductibles, coinsurance, and copayments — and there's no annual out-of-pocket maximum under Original Medicare alone. That means a serious illness or extended hospital stay could result in significant out-of-pocket costs with no cap. The most common coverage gaps people run into include:
- The Part A deductible — a set amount you pay before Part A starts covering an inpatient hospital stay, per benefit period.
- Part B coinsurance — typically 20% of the Medicare-approved amount for most doctor services and outpatient care, with no upper limit.
- Skilled nursing facility costs — Part A covers a limited number of days, with coinsurance kicking in after the first 20 days.
- No out-of-pocket maximum — unlike Medicare Advantage plans, Original Medicare by itself doesn't cap what you could pay out of pocket in a year.
How Medicare Supplement Plans Fill the Gaps
A Medicare Supplement (Medigap) policy is designed specifically to pay some or all of these leftover costs — the deductibles, coinsurance, and copayments that Original Medicare doesn't cover. Depending on the plan you choose, a Medigap policy can cover most or nearly all of your Part A and Part B cost-sharing, which is why Medigap plans generally carry a higher monthly premium than Medicare Advantage: you're paying more up front for far more predictable costs later. Medigap plans are standardized by letter (like Plan G or Plan N), so the core benefits of a given plan letter are the same no matter which insurance company sells it — only the premium and the carrier's service tend to differ.
Medigap does not include prescription drug coverage, so most people who choose a Medigap plan pair it with a standalone Part D plan to cover medications. And because Medigap plans have no provider networks, they travel with you nationwide — you can see any doctor or hospital that accepts Medicare, without referrals or prior authorization for covered services.
| Feature | Medicare Advantage (Part C) | Medigap (Medicare Supplement) |
|---|---|---|
| Monthly premium | Often lower, sometimes $0 | Generally higher |
| Provider network | Usually HMO/PPO network restrictions | Any doctor who accepts Medicare, nationwide |
| Extra benefits | May include dental, vision, hearing, fitness | Typically none — pairs with a separate Part D plan |
| Out-of-pocket costs | Copays/coinsurance, annual out-of-pocket max | Very predictable, often minimal cost-sharing |
| Referrals | May be required for specialists (HMO plans) | Not required |
| Prescription drugs | Usually bundled in | Requires a separate Part D plan |
| Travel flexibility | Limited outside plan service area (except emergencies) | Coverage travels with you nationwide |
Medicare Advantage — At a Glance
Potential pros: often lower monthly premiums, extra benefits like dental and vision, an annual out-of-pocket maximum.
Potential trade-offs: care is typically limited to an in-network provider list, and some services may require prior authorization or referrals. Recall that Part C is one of the four core parts of Medicare.
Medigap — At a Glance
Potential pros: freedom to see any provider who accepts Medicare, predictable cost-sharing, no networks.
Potential trade-offs: higher monthly premiums, and prescription drug coverage must be purchased separately through Part D. If you're still working, see how employer coverage factors into this decision.
This comparison is educational only. It is not a recommendation of any specific plan. The right choice depends on your personal health needs, budget, and provider preferences — a licensed insurance agent can help you weigh your specific situation. You can review official plan details anytime at Medicare.gov.
How to Compare Total Annual Cost, Not Just Premium
The single most common mistake in comparing Medicare Advantage to Medigap is looking only at the monthly premium. A $0-premium Medicare Advantage plan can end up costing more in a year with a major surgery or hospital stay than a Medigap plan with a $170/month premium, once you account for copays, coinsurance, and how close you get to the plan's out-of-pocket maximum. To compare fairly, estimate your total annual cost for each option:
- Add up fixed costs: 12 months of premiums for the plan itself, plus your Part B premium ($202.90/month in 2026) and any Part D premium if not bundled in.
- Estimate variable costs: based on your actual healthcare use last year — how many doctor visits, any planned procedures, and your regular prescriptions — apply the plan's specific copay/coinsurance structure to that usage.
- Check the out-of-pocket maximum: for Medicare Advantage, this is your worst-case annual cost ceiling. For Medigap, add up the plan's known deductibles since there's no equivalent single cap, but Medigap's coverage is generally much more predictable to begin with.
Running this comparison with your own numbers — not just the advertised premium — is the only reliable way to know which option actually costs less for your specific situation. See our full 2026 cost breakdown for the exact Part A and Part B figures to plug into this estimate.
Understanding Drug Formularies
If you're comparing Medicare Advantage plans (which usually bundle Part D) or standalone Part D plans to pair with Medigap, the plan's formulary — its specific list of covered drugs and their cost tiers — matters as much as the premium. Two plans with identical premiums can have very different costs for the exact same medication, depending on which tier they place it in. Lower tiers (typically generics) cost less than higher tiers (typically brand-name or specialty drugs).
Formularies aren't fixed — plans can change them from year to year, sometimes removing a drug or moving it to a more expensive tier. Before enrolling in any plan, check its current formulary against your specific medications, and re-check every year during AEP even if you're satisfied with your current plan. As of 2026, all Part D coverage — whether standalone or bundled into Medicare Advantage — includes a $2,100 annual out-of-pocket cap on covered drugs.
For a deeper walkthrough of this decision, including cost considerations and network tradeoffs, see our blog postMedicare Advantage vs. Medigap: How to Choose the Right Coverage in 2026.
Frequently Asked Questions
Can I switch from Medicare Advantage to Medigap later?
You can generally switch, but outside of certain protected windows, a Medigap insurer may use medical underwriting to accept or deny your application or charge more based on health history.
Does Medicare Advantage or Medigap have lower monthly premiums?
Medicare Advantage plans often have lower monthly premiums, sometimes $0, while Medigap plans generally carry higher monthly premiums in exchange for more predictable cost-sharing.
Do Medicare Advantage plans restrict which doctors I can see?
Usually, yes. Medicare Advantage plans typically use HMO or PPO provider networks, while Medigap lets you see any doctor nationwide who accepts Medicare.
Does Medigap include prescription drug coverage?
No. Medigap plans typically don't include drug coverage, so you'd need to pair a Medigap policy with a separate Part D plan.
What does Original Medicare not cover?
Original Medicare generally does not cover routine dental, vision, or hearing care, most long-term custodial care, and prescription drugs. These are the most common coverage gaps that Medicare Advantage extra benefits or Medigap plus a separate Part D plan are designed to help address.
How does a Medicare Supplement plan fill Medicare's coverage gaps?
A Medicare Supplement (Medigap) plan pays some or all of the out-of-pocket costs Original Medicare leaves behind, such as coinsurance, copayments, and deductibles, so you're not exposed to unlimited out-of-pocket costs when you need care.
Still weighing your options? Take the Medicare Decision Style Quiz orschedule a consultation with a licensed insurance agent.
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