Medicare Supplement (Medigap), Medicare Advantage, and Part D: A Simple Guide for Seniors
Choosing Medicare coverage can feel confusing. We are here to make it easy and help you find a plan that fits your health needs and budget—and connect you with trusted eldercare services nearby.
Quick comparison at a glance
Medigap (Medicare Supplement): Adds coverage to Original Medicare (Parts A and B) to reduce your costs. Higher monthly premium, very low or no bills when you get care. You keep Original Medicare’s nationwide access.
Medicare Advantage (Part C): All‑in‑one plan from private insurers. Often includes drug coverage, dental, vision, and hearing. Lower monthly premiums, but you pay copays when you get care. Uses provider networks (HMO, PPO).
Part D (Prescription Drug Plan): Stand‑alone drug coverage you can add to Original Medicare (or included with many Medicare Advantage plans).
Medigap (Medicare Supplement) plans
What it is
Private insurance that helps pay Original Medicare’s out‑of‑pocket costs (like deductibles and coinsurance).
Why seniors choose it
Predictable costs and flexibility to see any provider that accepts Medicare nationwide.
No network restrictions, no referrals needed.
Keep in mind
Monthly premiums are higher than most Medicare Advantage plans.
Does not include drug, dental, or vision. You can add a stand‑alone Part D plan.
You must be enrolled in Medicare Parts A and B.
Best fit for
Seniors who travel, have multiple specialists, or want very low bills at the time of service.
Medicare Advantage (Part C) plans, including MAPD
What it is
Private plans that provide your Medicare Part A and B benefits and often include Part D drug coverage (MAPD). May include extras like dental, vision, hearing, fitness, and transportation.
Why seniors choose it
Lower monthly premiums (some plans as low as $0, depending on your area).
Extra benefits not included in Original Medicare.
Keep in mind
You’ll use the plan’s network and may need referrals or prior authorizations.
You’ll pay copays as you use services, up to an annual maximum out‑of‑pocket limit.
Coverage, costs, and provider networks vary by county and plan.
Common plan types
HMO (Health Maintenance Organization): Lowest costs, must use in‑network providers (except emergencies).
PPO (Preferred Provider Organization): More provider flexibility, higher costs if you go out‑of‑network.
PFFS (Private Fee‑for‑Service): Use any provider that accepts the plan’s terms for payment.
MA‑only vs. MAPD: Some Advantage plans include drug coverage (MAPD); some do not (MA‑only).
Important note: You cannot use a Medigap policy with a Medicare Advantage plan.
Prescription Drug Plans (Part D)
What it is
Stand‑alone drug plans you can add to Original Medicare (and Medigap). Included in many Medicare Advantage plans.
How to choose
Confirm your medications are on the plan’s formulary (drug list) and check the tier and copay.
Compare preferred pharmacies and mail‑order options.
Review the plan’s annual deductible and coverage gap rules.
Costs at a glance
Premium: What you pay each month to keep your plan.
Deductible: What you pay before your plan pays.
Copays/coinsurance: What you pay when you use care or fill prescriptions.
Out‑of‑pocket maximum (MOOP): Applies to Medicare Advantage; protects you from unlimited costs in a year. Original Medicare has no MOOP unless you add Medigap.
When you can enroll
Initial Enrollment Period: 3 months before to 3 months after you turn 65 and sign up for Part B.
Annual Enrollment Period (Oct 15–Dec 7): Switch between Original Medicare and Medicare Advantage; change Part D plans; coverage begins Jan 1.
Medicare Advantage Open Enrollment (Jan 1–Mar 31): If you’re already in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or go back to Original Medicare and join a Part D plan.
Special Enrollment Periods: Certain life events (moving, losing coverage, qualifying for Extra Help) may allow changes outside these windows.
How to choose the right coverage in 4 simple steps
1. List your doctors, hospitals, and medications.
2. Decide what matters most: lowest monthly cost, widest provider choice, or extra benefits.
3. Compare plans in your ZIP code: premiums, drug coverage, copays, networks, and your annual maximum costs.
3. Get a personalized review with a licensed agent to confirm your doctors and drugs are covered: (800) 989-8137
Frequently Asked Questions
Do I need both a Medigap and a Medicare Advantage plan?
No. You can have either Medigap with Original Medicare, or a Medicare Advantage plan—not both.
Is prescription drug coverage included in Medigap?
No. Medigap does not include drugs. Add a stand‑alone Part D plan if you stay with Original Medicare.
Can I keep my doctors with Medicare Advantage?
It depends on the plan’s network. Check that your providers are in‑network before you enroll.
Are Medicare Advantage plans free?
Some plans offer $0 premiums, but you’ll still pay copays when you use care, up to the plan’s annual out‑of‑pocket maximum.
Do plans and benefits vary by location?
Yes. Plans, premiums, and provider networks vary by county and insurer.
