One of the most critical healthcare institutions in the United States, Medicare is a staple for many people seeking affordable medical help when retired. As part of the Medicare program, Medigap or Medicare Advantage are two supplemental policies that can boost your overall coverage options.
Unfortunately, you can’t have both, so you have to choose between signing up for Medicare Advantage or Medigap. Ultimately, this means you have to choose between one or the other and consider all the factors involved, including which doctors you can see and how much each plan might cost you in the long and short term.
What Medicare Covers
To understand why you might choose between Medicare Advantage and Medigap, you must consider what Medicare currently covers. Part A ensures hospital insurance coverage, while Part B covers your standard medical insurance. However, this leaves gaps with deductibles, copayments, and coinsurance, and there is no coverage for prescription drugs (Part D) and dental, vision, or hearing.
As a result, you can purchase Medicare Advantage or Medigap to help you fill in any coverage gaps and end up with a more full-circle medical plan that covers most or all of your needs.
What Is Medicare Advantage?
Known as Part C of Medicare, Medicare Advantage allows those currently enrolled in Medicare to enjoy the original Medicare plan from a private health provider, not the government. This generally includes choosing an HMO or PPO plan, which are the two most common options.
Any plan under Medicare Advantage must match the same type of coverage as government-run Medicare. Still, it could be bundled with packages that original Medicare doesn’t cover, generally including prescription drug coverage. The biggest benefit of this plan is that it also likely offers vision, dental, and hearing benefits. On the con side, Medicare Advantage is accepted by fewer healthcare professionals and hospitals. Additionally, 2026 regulations have introduced faster prior authorization timelines, requiring plans to provide urgent decisions within 72 hours.
What Is Medigap?
If you choose to enroll in Medigap, you will receive an additional insurance policy from a private insurer in your state, and it is only a supplemental policy to Medicare. The purpose of Medigap is to provide the subscriber with any coverage “gaps” that original Medicare does not provide.
This generally allows you to choose from one of ten Medigap plans, which will help you pay out-of-pocket costs that you receive from Medicare. However, it’s essential to know that Medigap doesn’t include long-term care, dental, vision, or hearing aids. In certain states, including Ohio and Texas, new pilot programs have recently introduced prior authorization requirements for specific outpatient procedures under Traditional Medicare, which may affect Medigap users.
Choosing Between Medicare Advantage and Medigap
Monthly Premiums
In 2026, the standard Part B premium has risen to $202.90, which serves as the baseline for both paths. Medicare Advantage plans remain a low-premium option, though $0 premium plans are becoming less common in some regions due to market contractions.
On the flip side, Medigap plans are expected to run between $65 and $450 monthly for coverage, depending on which of the 10 different Medigap plans you choose from and where you live. While Plan G remains a top choice, Plan N has gained popularity for offering lower premiums in exchange for small copayments at the point of care.
Network Limits
Another primary consideration when choosing between these plans is what kind of network you are comfortable with. For all its advantages, Medicare Advantage has some flags around only allowing enrollees to use in-network providers. However, some major insurers are now “gold-carding” certain providers to eliminate prior authorization hurdles for specific services.
In the case of the Medigap plan, you don’t have any actual network limits or restrictions. You can visit and receive care if a doctor or hospital accepts Medicare. Suppose you live in multiple states, such as those who snowbird between New York and Florida, this plan can be ideal, especially for retirees who don’t want to worry about finding new doctors.
Additional Benefits and Drug Coverage
The Inflation Reduction Act has significantly altered the value of drug coverage for 2026. All Medicare plans now feature a $2,000 annual out-of-pocket cap on prescription drugs. Furthermore, Medicare has begun implementing negotiated prices for ten high-volume medications, such as Eliquis and Jardiance.
One of the primary benefits of going with a Medicare Advantage plan that includes Part D is that medication coverage is included in your plan. In the case of Medigap, you must purchase a standalone Part D plan, though you can now utilize the Medicare Prescription Payment Plan to spread drug costs evenly throughout the year.
Key Factors to Consider
Health Needs
Anyone who is considering between these two options should have a good idea of what their individual health needs are. Medigap will be the better choice for anyone who needs frequent medical care as it offers lower out-of-pocket costs. Alternatively, Medicare Advantage can be sufficient if you are healthy and don’t frequently visit doctors except for annual checkups.
Travel Preferences
Assume for a moment you are a frequent traveler. In this case, you want to consider that Medigap will offer nationwide coverage. This is a huge benefit you can’t ignore, and as long as you can find a medical facility that takes Medicare, you will be covered.
If you have Medicare Advantage, you might struggle to find a local hospital or care service that takes your medical plan in case of an emergency. On the other hand, if you don’t stray far from home, Medicare Advantage may be adequate.
Budget Constraints
Arguably, the most significant consideration between these two plans will focus heavily on your current budget situation. In 2026, the Part B deductible has increased to $283, and the Part A hospital deductible sits at $1,736. Medigap plans often cover these high front-end costs, providing more predictable monthly expenses for those on a fixed income.
Evaluating The Plans
Before you decide between Medicare Advantage and Medigap, consider all the coverage details available. This would include looking at both plans’ benefits, restrictions, and costs. Knowing the different premiums, copayments, out-of-pocket maximums, and deductibles is essential, as you don’t want any financial surprises throughout a calendar year.
Separately, talk to your current doctor and confirm they are in network with Medicare Advantage. Due to recent provider network exits by major insurers, it is critical to verify your doctor’s status for the current plan year.
Last but not least, consider all of your future needs. Do you anticipate traveling more? Are you concerned about your overall health? The answer to these questions and those like them will help you make the most educated decisions between the plans.
Editor’s Note: This article contains updated financial figures for 2026, including the new Part B premium and deductible rates. It incorporates information regarding the federal $2,000 prescription drug out-of-pocket cap and the commencement of Medicare price negotiations for high-cost medications. New sections address federal prior authorization reforms, recent insurer network contractions, and the implementation of outpatient pilot programs in select states.
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