Opinion: Understanding Medicare Advantage vs. Medicare supplements

Adam Kyle

When someone is turning 65 or going on Medicare for the first time, the first major decision they need to make is: “Do I want to go on a Medicare health plan,” and, “If so, which kind do I want?” This is where most major stress over the Medicare process comes in.

If you do want to go with a Medicare health plan, you have two options: Medicare supplements (also called Medigap), and the Part C/Medicare Advantage Plan. They are both great options, but for many people, one may be a better option than the other.

When someone comes into my office and they are new to the Medicare process, I present both options, highlighting their strengths and weaknesses.

First, let’s talk Medigap plans. The coverage itself is standardized by the Centers for Medicare & Medicaid Services, so it’s the exact same coverage with whatever company you go with. At that point, you’re basically just shopping premiums. Some companies will add in a gym membership, but not many.

Medigap plans are a secondary payer to original Medicare (Parts A and B). The benefit to this structure is that the insurance company you go through is making no coverage determinations. If Medicare approves it, the Medigap plan is required to pay. The downside to this is that the Medigap plan only covers what original Medicare covers, so no dental, routine vision or hearing coverage. Also, like original Medicare, you can go to any provider that accepts Medicare assignment, though there is no prescription coverage, requiring the purchase of a separate Rx plan.

There is a surplus of great charts online that compare the different kinds of Medigap plans, but the most popular one in my experience is the Plan G. Your only out-of-pocket cost is the Part B deductible set by Medicare ($283 in 2026). After that, it is 100% coverage for all health care costs.
There are three major downsides to Medigap plans:

1. They are expensive. A 65-year-old male, nonsmoker, can expect to pay roughly an additional $175/month in addition to the Part B premium of $202.90. Plus, the Rx plan premium, which can range from anywhere to roughly $10-$145/month in this area.

2. They do not come with extra benefits like routine dental, vision and hearing.

3. With the exception of a few guarantee issue periods, you must pass a health questionnaire to qualify, and they are very strict. They are not legally required to take you.

This leads us to Medicare Advantage/Part C plans, which are required to take you, as long as you have Parts A and B and live in a county where plans are offered.

MA plans function like traditional health insurance. You have copays, coinsurances and a maximum out-of-pocket, but likely better than any insurance you’ve ever had before. They also almost always include Rx coverage for no extra cost, as well as extras like dental, vision, hearing, gym memberships and OTC allowances.

These plan benefits vary from company to company, but every MA insurer is required to cover everything original Medicare covers, but they likely do it at a lower cost to you.

The benefits of MA plans are that you don’t have to answer health questions, you get extra benefits, and best of all, they are $0-very low monthly premium. The premium alone makes these an attractive option.

The downside to these plans is that they are network-based (like HMOs and PPOs), just like any other health insurance you’ve had before. But, compared to the Medigap, this is a downside. Also, with MA plans, original Medicare pays them to take over your Medicare benefits, meaning the insurance company has a say in how your health care is managed, just like traditional insurance.

So, in summation, both plans are great options, but what you need to think about is your immediate health and financial needs, current and potentially future providers, whether or not you’re at risk for certain health problems via family history, and whether or not you can afford the rising premiums of Medigap plans. In my experience, 95% of clients do not regret the option their gut told them to go with when signing up, no matter which one it was.

Adam Kyle is a broker for Medicare Health Plans in southwest Missouri. He can be reached at adam@kyleinsuranceservices.com.