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Side by side

Two routes. Seven questions. No best answer.

Anyone who tells you one of these is simply better than the other is selling one of them. What follows is the same comparison we would put on the table in front of you, including the parts that do not flatter either side.

Have someone do this with me Go straight to the questions

The shape of the choice

Everything reduces to these two.

Part D is not a third route — it is a component of both. The real decision is whether a private plan administers your Medicare, or whether you keep Original Medicare and buy something to sit behind it.

Route one

Original Medicare, topped up

Part A + Part B + a Medigap policy + a standalone Part D plan

What you get

  • Any doctor or hospital that takes Medicare
  • No networks, referrals or prior authorisation
  • Very little variability once the premium is paid
  • The policy is standardised, so it does not change under you

What it asks of you

  • Highest fixed monthly cost of the two routes
  • Three separate premiums to keep track of
  • Medigap can be medically underwritten outside your windows

Route two

A Medicare Advantage plan

Part C, usually with Part D built in

What you get

  • Often no plan premium at all
  • A hard annual ceiling on in-network Part A and B costs
  • Extras: dental, vision, hearing, fitness, over-the-counter
  • One card, one plan, one phone number

What it asks of you

  • A network, a service area and often prior authorisation
  • Copays that arrive when you are already unwell
  • Everything can change on 1 January and needs an annual review

Seven questions

Answered three ways, honestly.

Original Medicare on its own is in here as a column because plenty of people are in exactly that position, and it is worth seeing what it does and does not do.

Which doctors can you see?

Original Medicare

Any provider in the United States that accepts Medicare. No referrals.

Medicare Advantage

The plan’s network, in the plan’s service area. HMOs usually need referrals.

Original + Supplement

Any provider that accepts Medicare, same as Original — the policy follows Medicare.

Is there a cap on what you can pay in a year?

Original Medicare

No. There is no annual out-of-pocket maximum on Parts A and B.

Medicare Advantage

Yes. Every plan has a MOOP for in-network Part A and B care. CMS sets the ceiling.

Original + Supplement

Plans G and N have no stated cap but leave very little uncovered. Plans K and L have a real annual limit.

What about prescriptions?

Original Medicare

Not included. You add a standalone Part D plan.

Medicare Advantage

Usually built in. A plan without drugs is an MA-only plan and it is worth checking which you are looking at.

Original + Supplement

Not included, and it cannot be. You add a standalone Part D plan.

Can you be turned down for health reasons?

Original Medicare

No.

Medicare Advantage

No. Advantage plans cannot use medical underwriting.

Original + Supplement

Yes, outside your guaranteed-issue windows. This is the single most important thing to understand about Medigap.

What does it cost each month?

Original Medicare

The Part B premium, plus IRMAA if your income is above the threshold.

Medicare Advantage

The Part B premium, plus the plan premium — often $0 — plus copays as you use care.

Original + Supplement

The Part B premium, plus the Medigap premium, plus a Part D premium. Higher fixed cost, lower variable cost.

What happens if you travel?

Original Medicare

Covered anywhere in the US. Almost nothing outside it.

Medicare Advantage

Emergency care travels. Routine care usually does not leave the service area.

Original + Supplement

Same US coverage as Original, and G and N add 80% foreign travel emergency up to a $50,000 lifetime maximum.

How often should you review it?

Original Medicare

Review the Part D plan every autumn.

Medicare Advantage

Every autumn without exception. Networks, formularies, copays and Star Ratings all reset on 1 January.

Original + Supplement

The policy itself is standardised and stable. Review the Part D plan every autumn.

If you go the Supplement route

Then it becomes a question of letters.

Federal standardisation means these benefits are identical whoever sells the policy. Only the premium, the rate history and the service change.

Scroll the table sideways to see Plans G, N, K and L.

What Medigap Plans G, N, K and L each pay towards the gaps Original Medicare leaves.
Benefit G Plan G N Plan N K Plan K L Plan L
Part A hospital coinsurance Plus 365 extra hospital days after Medicare benefits are used up. 100% Covered in full 100% Covered in full 100% Covered in full 100% Covered in full
Part A deductible Charged once per benefit period, not once per year. 100% Covered in full 100% Covered in full 50% Partly covered 75% Partly covered
Part B coinsurance or copayment The 20% Original Medicare leaves you with on most outpatient care. 100% Covered in full 100% less copays Conditional 50% Partly covered 75% Partly covered
Part B deductible No plan sold to people newly eligible since 2020 may cover this. Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered
Part B excess charges What a non-participating doctor may bill above the Medicare rate. 100% Covered in full Not covered Not covered Not covered Not covered Not covered Not covered
Skilled nursing facility coinsurance Days 21 to 100 of a qualifying skilled nursing stay. 100% Covered in full 100% Covered in full 50% Partly covered 75% Partly covered
First three pints of blood The three pints a year Original Medicare does not pay for. 100% Covered in full 100% Covered in full 50% Partly covered 75% Partly covered
Part A hospice coinsurance Respite care and outpatient drugs under the hospice benefit. 100% Covered in full 100% Covered in full 50% Partly covered 75% Partly covered
Foreign travel emergency Care in the first 60 days of a trip, up to a $50,000 lifetime maximum. 80% Partly covered 80% Partly covered Not covered Not covered Not covered Not covered
Annual out-of-pocket limit Only K and L have one. CMS resets the amount every year. None Not covered None Not covered Yes — higher Conditional Yes — lower Conditional

Medigap policies are standardised by federal law, so a Plan G is a Plan G whoever sells it — only the price, the service and the rate history differ. Massachusetts, Minnesota and Wisconsin standardise their policies differently. Plans F and C are closed to anyone newly eligible for Medicare on or after 1 January 2020. The annual out-of-pocket limits on Plans K and L are reset by CMS each year.

The full Medicare Supplement page

How to decide

Answer these four, in this order.

  1. Who do you refuse to give up?

    Name the doctors and the hospital. If they are not in any Advantage network near you, the decision is largely made.

  2. What do you take, and how much does it cost on each plan?

    Every prescription against every formulary. This changes the annual arithmetic more often than the premium does.

  3. How much variability can you live with?

    A fixed premium and almost no bills, or a low premium and copays capped by a MOOP. Both are defensible. Only one will let you sleep.

  4. Where will you be in ten years?

    Travel, a second home, a move to be near family, a condition that runs in the family. The Medigap door is easiest to walk through now.

The asymmetry worth understanding

Moving from a Supplement to an Advantage plan is straightforward at almost any Annual Enrollment Period. Moving the other way can require passing medical underwriting, and health is not something you schedule. That does not make Advantage wrong — it makes the first decision worth more of your time.

Asked often

Is Medicare Advantage cheaper than a Medicare Supplement?
Cheaper each month, usually. Cheaper over a year, only if you do not use much care. Advantage moves cost from the fixed column to the variable one: a lower or zero plan premium in exchange for copays as you go, capped by the plan’s annual maximum out-of-pocket. A Supplement does the reverse. Which is cheaper for you depends entirely on how much care you use, and neither answer is generally true.
Can I switch from Medicare Advantage to a Supplement later?
You can apply, but outside a guaranteed-issue window most states allow the insurer to medically underwrite you — so the answer depends on your health at the time rather than on your intention. There is a trial right in the first twelve months of your first Advantage plan, and specific guaranteed-issue events after that. This asymmetry is the reason the first decision deserves more time than it usually gets.
Which route do most people choose?
Roughly half of people with Medicare are in an Advantage plan and the share has grown steadily. That is a fact about the market, not a recommendation. Popularity says something about premiums and marketing budgets and very little about whether a plan fits your doctors, your prescriptions and your travel.

We will run both routes on your actual numbers.

Your doctors, your prescriptions, your ZIP code, your travel. One conversation, both routes priced over a full year, and a clear statement of where each one would hurt.

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