This is the decision that trips up almost everyone turning 65. Medigap or Medicare Advantage? They sound similar. They fill a similar gap. And nearly every explanation of the difference you'll find online was written by someone who is paid differently based on which one you choose.
This explanation is not. Here is the genuine comparison.
Original Medicare (Parts A and B) covers a lot — but it does not cover everything, and it has no out-of-pocket maximum. Without a cap on your costs, a serious illness could mean thousands of dollars in hospital copays and deductibles in a single year. Both Medigap and Medicare Advantage exist to fill that gap — they just do it differently.
Medigap (also called Medicare Supplement) is a private insurance policy that works alongside Original Medicare. You keep Original Medicare as your primary insurance. Medigap pays after Medicare pays, covering some or all of what Medicare left behind — copays, coinsurance, deductibles.
The most popular Medigap plan, Plan G, covers almost everything Medicare does not cover except the Part B deductible ($257 in 2026). After you meet that annual deductible, you pay essentially nothing out of pocket for Medicare-covered services for the rest of the year.
Medigap policies are standardized — Plan G from one company covers exactly the same things as Plan G from any other company. You are just shopping on price and carrier reputation. And you can see any doctor or hospital that accepts Medicare, anywhere in the country. No network. No referrals needed.
Medicare Advantage (Part C) is a different approach entirely. Instead of Original Medicare paying first and a supplement paying second, you hand your Medicare benefits over to a private insurance company, which then manages all your coverage. The federal government pays that company to cover you.
Medicare Advantage plans typically include prescription drug coverage, and many include extra benefits not covered by Original Medicare — dental, vision, hearing, fitness memberships. Many plans have $0 monthly premiums beyond what you're already paying for Part B.
The tradeoff: you are working within a network. You generally need to use doctors and hospitals in the plan's network, get referrals to see specialists, and manage prior authorizations for some services. And you have an annual out-of-pocket maximum — but that maximum can be several thousand dollars, not zero.
| Factor | Medigap (Plan G) | Medicare Advantage |
|---|---|---|
| Monthly premium | $150–$250+ (added to Part B) | Often $0 (beyond Part B) |
| Out-of-pocket max | Near zero after Part B deductible | Up to $3,000–$8,000/year |
| Network restrictions | None — any Medicare provider | Yes — in-network only for most plans |
| Referrals needed | No | Often yes (HMO plans) |
| Drug coverage | Requires separate Part D plan | Usually included |
| Dental/vision/hearing | Not included | Often included |
| Commonly chosen by | People with frequent or complex medical needs; frequent travelers; people who prioritize cost predictability | People in good health with lower anticipated medical use; people who want added benefits; people managing monthly premium costs |
People who use Medigap tend to have frequent or complex medical needs — multiple specialists, chronic conditions, or a history of hospitalizations. In those situations, the higher monthly premium is often offset by significantly lower out-of-pocket costs throughout the year. Medigap is also common among people who travel frequently, since it works with any Medicare-accepting provider in the country with no network restrictions. People who place a high value on knowing their healthcare costs in advance often gravitate toward Medigap for that reason.
Only you — ideally with input from a free SHIP counselor — can assess whether this pattern fits your situation.
Medicare Advantage tends to be used by people who are in relatively good health and do not anticipate frequent or complex medical care. The $0-premium structure appeals to people managing monthly costs, and the added benefits — dental, vision, hearing, fitness — can provide real value for those who use them. The important thing to understand with Medicare Advantage is what the out-of-pocket maximum means in a year when something unexpected happens — that number varies significantly by plan.
A free SHIP counselor can help you compare specific plan options in your area at no charge. Find yours at shiphelp.org.
Neither option is universally better, and Ready at 65 is not in a position to tell you which one is right for your situation — that depends on your health, your doctors, your prescriptions, your budget, and your tolerance for financial uncertainty. What this article can do is help you understand what each option actually is, so you can have an informed conversation with a licensed professional or a free SHIP counselor before you decide.
There is a narrow window — called your Medigap Open Enrollment Period — during which insurance companies must sell you any Medigap plan at standard rates, regardless of your health history. This window opens when you are 65 and enrolled in Part B, and lasts six months. Outside this window, companies in most states can charge you more or deny coverage based on your health. Getting a Medigap plan during this window is much simpler and cheaper than trying later.
Reminder: Ready at 65 is not affiliated with Medicare, CMS, the SSA, or any government agency. This article is general educational information, not financial, legal, medical, or insurance advice. Rules, costs, and deadlines change — verify current details at Medicare.gov or by calling 1-800-MEDICARE before making any decision. Full disclaimer →