01Path one
Original Medicare, Medigap, and a Part D plan
Three pieces that you assemble. No network anywhere in the country, no referrals, and predictable cost sharing, in exchange for paying a Medigap premium and a drug plan premium every month.
Side by side
Two ways to finish your Medicare coverage.
Almost every Medicare decision comes down to this fork: assemble Original Medicare with a Medigap policy and a drug plan, or take a single Medicare Advantage plan. Here is what actually separates them.
The fork
You are not choosing between good and bad.
You are choosing which trade you would rather make: freedom of provider paid for monthly, or lower monthly cost inside a network.
02Path two
A single Medicare Advantage plan
One plan from a private insurer, usually with drug coverage and often with extra dental, vision, or hearing benefits. Lower monthly cost for many people, in exchange for using a network and paying as you go up to an annual maximum.
Path one
Original Medicare with Medigap and Part D.
- Providers: any doctor or hospital in the country that accepts Medicare, with no referrals.
- Out-of-pocket costs: the Medigap policy absorbs most Medicare cost sharing, so what you owe is largely fixed and paid as premium.
- Drug coverage: bought separately as a standalone Part D plan.
- Extras: no routine dental, vision, or hearing coverage included. You would buy those separately if you want them.
- Travel: works anywhere in the country, and some Medigap letters include limited foreign travel emergency coverage.
- Switching later: moving to Medicare Advantage is straightforward during an enrollment window.
Path two
A single Medicare Advantage plan.
- Providers: the plan network, with HMO plans generally requiring you to stay in it and PPO plans charging more to leave it.
- Out-of-pocket costs: copays and coinsurance when you use care, capped by an annual out-of-pocket maximum set by the plan.
- Drug coverage: included in most plans, so there is one plan and one card.
- Extras: many plans include some dental, vision, hearing, or fitness benefits, with allowances that vary widely.
- Travel: emergency and urgent care is covered nationwide, but routine care outside the service area usually is not.
- Switching later: you can return to Original Medicare in a window, but your right to buy a Medigap policy without underwriting may be limited by then.
How to decide
Six questions that usually settle it.
Answer these with your own doctors, prescriptions, and travel habits in front of you. In practice, the first and the last question decide the outcome for most people.
- Do you have doctors or a hospital you are unwilling to change? That points toward Original Medicare with a Medigap policy.
- Do you split the year between two states, or travel for months at a time? Network rules matter more than premiums in that case.
- Would you rather pay a steady premium every month, or pay less monthly and more on the days you use care?
- How would an unexpected year of surgery, rehabilitation, and follow-up look under each option, using the plan out-of-pocket maximum as the worst case?
- Are you inside your 6-month Medigap open enrollment window right now? If so, that door is open with no health questions, and it does not reopen.
- Do the extra benefits in Advantage plans near you actually cover what you would use, at an allowance that is worth the network trade?
Timing
The windows that constrain the choice.
- Medigap open enrollment, with no health questions
- 6 months
- Annual Enrollment Period for Advantage and Part D
- Oct 15 to Dec 7
- Medicare Advantage Open Enrollment, one change
- Jan 1 to Mar 31
- is paid by Part A on either path
- Hospice
Good to know
Questions people ask when comparing.
Which one is cheaper?
Neither is cheaper in general, and the honest comparison depends on how much care you use. Medicare Advantage usually costs less per month and more when you get care. Original Medicare with a Medigap policy usually costs more per month and much less at the point of care. Compare a normal year and a bad year side by side rather than only the premiums.
Can I try one and switch later?
You can switch during the right window, but the two directions are not equally easy. Moving from Medigap to Medicare Advantage is generally simple. Moving back to Original Medicare and buying a Medigap policy later may require medical underwriting, depending on your state and your situation, so the return trip is the one to think about before you decide.
Can I keep my employer or retiree coverage instead?
Sometimes, and it can be a good option. How employer or retiree coverage coordinates with Medicare depends on the size of the employer and whether the coverage is active or retiree, and enrolling in the wrong thing at the wrong time can cost you either the coverage or a penalty. Check with the benefits administrator before you make any change.
Do both options cover the same medical services?
A Medicare Advantage plan has to cover everything Original Medicare covers, apart from hospice, which Part A keeps paying for. What differs is how you access those services, what you pay for them, and whether the plan adds benefits Medicare does not cover.
What if I qualify for both Medicare and Medicaid?
You may be able to enroll in a Dual Eligible Special Needs Plan, a type of Medicare Advantage plan built to coordinate both programs, and you may qualify for help with premiums and drug costs. Rules and available plans vary by state, so start with your ZIP code.
Your county
Compare both Medicare paths where you live.
Enter your ZIP code to see the Advantage plans, Medigap policies, and drug plans available to you.