Medicare Supplement vs
Medicare Advantage
Understanding the fundamental differences between these two Medicare options to make the right choice for your healthcare needs.
Two Different Approaches to Medicare
Medicare Supplement
Works WITH Original Medicare to cover the gaps—deductibles, copays, and coinsurance.
- Any Medicare doctor nationwide
- No networks or referrals
- No prior authorizations
- Predictable out-of-pocket costs
- Higher monthly premiums ($80-$160)
- No dental/vision included
Medicare Advantage
REPLACES Original Medicare with a private insurance plan, often including extra benefits.
- Lower monthly premiums ($0-$167)
- Prescription drugs usually included
- Extra benefits: dental, vision, hearing
- Out-of-pocket maximum protection
- Must use network providers
- Higher costs when you need care
Compare Every Detail
A comprehensive feature-by-feature comparison to help you understand the differences.
| Feature | Medicare Supplement | Medicare Advantage |
|---|---|---|
| Medicare Part A & B | Required | Required |
| Original Medicare | Works with Part A & B | Replaces Part A & B |
| Premium | $80–$160 | $0–$167 |
| Prescription Drugs | Separate Part D plan required | Usually Included |
| Choose Best Drug Plan? | Yes | No—take what company gives you |
| Out of Pocket Costs | After Part B deductible, pays 100% | Has Copays and Coinsurance up to $13,300 |
| Maximum Out of Pocket | $0—Pays 100% | $9,250 In-Network, $13,900 for In-Network and Out-Network combined |
| Prior Authorization | No, No, and No again! | Insurance company decides what treatment you can have—NOT your doctor |
| Guaranteed Renewable? | Yes | No—Plans change every year. Plans are canceled every year. |
| Benefits Medicare doesn't cover? | No | Some, like dental and vision |
| Healthcare expenses | Pays ALL out-of-pocket costs after Medicare pays its share | Insurance Company Responsible for paying for Healthcare, not Medicare |
| Choose your doctor and hospital? | Yes—Can use ANY doctor in USA that accepts Medicare. Can use ANY Hospital in USA | NO—Must use insurance company's limited doctor/hospital Network |
| Specialist referral required? | No | Yes—Most HMOs require specialist referral |
| Cost Sharing | No, except for Plan N which has $20 doctor and $50 emergency room | $0–$13,900 |
| Deductibles | Annual Part B $257 deductible | Up to $615 for Prescription Drugs |
| Covered out of town? | Anywhere in USA, $50,000 out of country | Only in life threatening emergency in USA |
| Expanded benefits | No | OTC, Home Meals after Hospital, transportation |
Important Note About Switching
It's much easier to start with Medicare Supplement than to switch to it later. After your initial enrollment period, insurance companies can require medical underwriting for Medicare Supplement plans, potentially denying you or charging higher rates based on health conditions. Consider your long-term needs carefully.
Which Plan is Right for You?
Medicare Supplement May Be Best If You:
- Value doctor freedom and want to see any Medicare doctor nationwide without networks or referrals
- Have complex health conditions and want to avoid prior authorization requirements
- Want predictable costs and don't want surprise copays when you need care
- Travel frequently and need coverage anywhere in the USA (or abroad)
- See specialists regularly and don't want referral requirements
- Can afford higher premiums in exchange for comprehensive coverage
Medicare Advantage May Be Best If You:
- Want lower monthly premiums and don't mind paying per-service when you need care
- Are generally healthy and don't expect to use healthcare services frequently
- Value extra benefits like dental, vision, hearing, and gym memberships
- Have doctors in the plan's network and don't mind staying in-network
- Stay in your local area and don't travel extensively
- Want all-in-one coverage including prescriptions, dental, and vision in a single plan
Still Not Sure?
This is one of the most important healthcare decisions you'll make. Contact us for a free consultation. We'll review your specific situation—your doctors, medications, budget, and health concerns—and help you choose the option that's truly best for YOU.
Common Misconceptions
Myth: "Medicare Advantage is always cheaper"
Reality: Medicare Advantage has lower monthly premiums, but can cost MORE overall if you actually need healthcare. With copays ($30-$100 per specialist visit), coinsurance (20% of expensive procedures), and deductibles, you could pay thousands out-of-pocket. Medicare Supplement has higher premiums but minimal costs when you need care—often better for people who use healthcare regularly.
Myth: "I can easily switch between them"
Reality: Switching FROM Medicare Advantage TO Medicare Supplement can be very difficult. After your initial enrollment period, insurance companies can deny you Medicare Supplement coverage or charge much higher rates based on your health. Many people get "stuck" in Medicare Advantage because they developed health conditions that make them uninsurable for Medigap. Going the other direction (Supplement to Advantage) is easy.
Myth: "Medicare Advantage networks are plenty big enough"
Reality: Networks can be very restrictive, especially for HMO plans. Your longtime specialists may not be in-network. If you're diagnosed with a rare condition, the best specialist might be out-of-network. Networks also change—doctors leave, hospitals drop out. With Medicare Supplement, you can see ANY Medicare doctor in the entire country without network restrictions.
Myth: "Prior authorization is just a formality"
Reality: Prior authorization in Medicare Advantage plans means the insurance company—not your doctor—decides if a treatment, test, or procedure is "medically necessary." Authorizations can be denied, delayed, or require extensive appeals. This can postpone needed care or force you to pay out-of-pocket. Medicare Supplement has ZERO prior authorization requirements—if Medicare approves it, the supplement pays its share automatically.
Let's Find Your Best Medicare Option
Get personalized guidance from Larry Fisackerly, a licensed Medicare insurance agent with 30+ years of experience. We'll review your specific situation and help you make the right choice.
Learn More About Each Option
Medicare Supplement
Deep dive into Medigap plans, coverage options, and enrollment details.
Medicare Advantage
Explore Medicare Advantage plan types, benefits, and what to consider.