Medicare Decision Navigator
What's your situation right now?
Let's start by understanding your current Medicare situation to give you the most relevant guidance.
What is Medicare Advantage (Part C)?
Medicare Advantage is private insurance that replaces Original Medicare (Parts A & B). Think of it as an all-in-one alternative to traditional Medicare.
Key Features:
• Usually $0 monthly premium (you still pay Medicare Part B premium of $202.90/month)
• Networks of doctors and hospitals
• Often includes prescription drugs (Part D)
• May include extra benefits like dental, vision, hearing aids
• Annual out-of-pocket maximum (protection Original Medicare lacks)
Dr. Ed's Insider Tip
Medicare Advantage plans change EVERY year. The plan you love this year might change its formulary, network, or costs next year. Always review your Annual Notice of Change in October.
How It Works:
1. Medicare pays the insurance company a set amount per month for your coverage
2. The company provides all your Medicare benefits through their network
3. You typically get a membership card and follow their rules for referrals, prior authorizations, etc.
What is Medigap (Medicare Supplement)?
Medigap is private insurance that supplements Original Medicare. It fills the "gaps" in Medicare coverage by paying your deductibles, coinsurance, and copayments.
Key Features:
• Works WITH Original Medicare (not instead of)
• Standardized plans (A, B, C, D, F, G, K, L, M, N)
• No networks - see any doctor who accepts Medicare
• Guaranteed renewable for life
• Same benefits nationwide
Dr. Ed's Insider Tip
Plan G is the most popular Medigap plan. Your only out-of-pocket cost is the $275 Part B deductible per year. Everything else is covered. It's like having a credit card that pays all your medical bills!
Most Popular Plans:
Plan G: Covers everything except Part B deductible ($275)
Plan N: Like Plan G but you pay up to $20 for office visits and $50 for ER visits
Plan F: Covers everything (only available if you qualified for Medicare before 2020)
Important: Medigap doesn't include prescription drug coverage. You'll need to buy a separate Part D plan if you want drug coverage.
Medicare Advantage vs Medigap: Quick Comparison
| Feature | Medicare Advantage | Medigap + Original Medicare |
|---|---|---|
| Monthly Premium | Often $0 (plus Part B) | $125-300+ (plus Part B) |
| Provider Network | Limited network | Any doctor accepting Medicare |
| Travel Coverage | Local/regional only | Nationwide |
| Specialist Referrals | Often required | Not required |
| Drug Coverage | Usually included | Buy separate Part D |
| Dental/Vision/Hearing | Often included | Not covered |
| Annual Changes | Plans change yearly | Stable coverage |
| Out-of-Pocket Maximum | Yes (around $8,850) | Low/no out-of-pocket |
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Which Option Is Right for Me?
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Medicare Advantage: Detailed Pros & Cons
✅ PROS
- Often $0 monthly premium
- Annual out-of-pocket maximum for protection
- Extra benefits like dental, vision, hearing aids
- Prescription drug coverage usually included
- Coordinated care through one plan
- Some plans offer wellness programs
❌ CONS
- Limited to plan's network of providers
- May need referrals to see specialists
- Plans can change benefits and costs annually
- Coverage mainly local/regional
- Prior authorization may be required
- Hard to switch to Medigap later without medical underwriting
Dr. Ed's Warning
Here's what insurance companies won't tell you: if you stay on Medicare Advantage for years and then want Medigap, you may face medical underwriting and could be denied or charged much more based on your health.
Medigap: Detailed Pros & Cons
✅ PROS
- See any doctor who accepts Medicare nationwide
- No referrals needed for specialists
- Stable, predictable coverage that doesn't change
- Excellent coverage with low out-of-pocket costs
- Guaranteed renewable for life
- Great for travelers and snowbirds
❌ CONS
- Monthly premium costs ($125-300+)
- No prescription drug coverage (need separate Part D)
- No extra benefits like dental, vision, hearing
- Must apply during specific enrollment periods
- Medical underwriting after Open Enrollment Period
- Premium increases over time
Dr. Ed's Golden Rule
The Medigap Open Enrollment Period is the most important 6 months of your Medicare life. It starts when you're 65+ AND enrolled in Medicare Part B. No company can deny you or charge more during this window.
Important Rules About Switching
Critical Information:
Understanding when and how you can switch between Medicare Advantage and Medigap is crucial for your future healthcare security.
Where are you in your Medicare journey?
Your current situation affects your options and timeline.
Real Cost Comparison (2026 Numbers)
Medicare Advantage Annual Costs
Monthly Premium: $0-50 (average $18)
Part B Premium: $202.90/month
Out-of-Pocket Maximum: ~$8,850
Prescription Drugs: Included
Total if healthy: ~$2,651/year
Total if sick: ~$11,500/year
Total if sick: ~$11,500/year
Medigap Plan G Annual Costs
Medigap Premium: $125-300/month (average $200)
Part B Premium: $202.90/month
Part B Deductible: $275/year
Part D Premium: ~$35/month
Total per year: ~$5,575-7,975
(Predictable regardless of health)
(Predictable regardless of health)
Dr. Ed's Cost Reality Check
Medicare Advantage looks cheaper upfront, but if you get seriously ill, you could hit that $8,850 out-of-pocket maximum every year. With Medigap Plan G, your costs are predictable: just the $275 Part B deductible annually.
Frequently Asked Questions
Your Decision Summary
Choose Medicare Advantage if: You want low monthly costs, don't mind networks, stay local, and want extra benefits like dental/vision.
Choose Medigap if: You want maximum flexibility, travel frequently, prefer predictable costs, and don't mind paying higher monthly premiums.