Medicare Advantage vs. Medigap: Which Plan Actually Saves You More in 2026?
| 2026 |
| medicare advantage plans |
| medicare supplement plans |
| medigap |
| question | answer |
|---|---|
| lower monthly premium | usually medicare advantage |
| wider provider choice | usually original medicare with medigap |
| predictable medical cost sharing | usually medigap |
| extra dental vision and hearing benefits | often medicare advantage |
| prescription coverage | usually included with medicare advantage |
| separate drug plan | usually required with medigap |
| final cost | depends on care use location doctors prescriptions and plan rules |
The lower premium is not always the lower total cost
The higher premium is not always the higher total cost
The plan with more benefits is not always the better fit
General Educational Disclaimer: This information is for general educational purposes only and is not insurance, tax, investment, legal, or financial advice. Coverage, eligibility, costs, and benefits depend on the specific policy, plan, carrier, and individual circumstances. Please speak with a properly licensed professional before making a decision.
Medicare Government-Affiliation Disclaimer: Holmes Health, Wealth & Business is not connected with or endorsed by the U.S. government or the federal Medicare program.
Medicare Options Disclaimer: Medicare Advantage and Medicare Supplement insurance are different products. Availability, premiums, benefits, provider networks, prescription coverage, and out-of-pocket costs vary by plan, carrier, service area, and individual circumstances.
No Guarantee Disclaimer: No coverage, enrollment, savings, claim payment, premium, or financial result is guaranteed. Eligibility and approval are determined under the applicable carrier and plan rules.
Plan-Specific Disclaimer: Benefits, premiums, deductibles, copayments, coinsurance, provider networks, formularies, and coverage rules vary by plan and may change. This information is not a complete description of benefits. Refer to the applicable plan documents and contact a licensed representative for current information.
| medicare coverage options |
| medicare frequently asked questions |
the basic structure
| medicare advantage plans | medicare supplement plans |
|---|---|
| private Medicare approved plan | private insurance used with original Medicare |
| part a coverage | original Medicare part a |
| part b coverage | original Medicare part b |
| usually part d coverage | separate part d plan |
| plan network | Medicare participating providers |
| plan copayments | Medicare cost sharing paid by the supplement |
| yearly part a and part b out of pocket limit | no single original Medicare limit |
| medicare advantage replaces the way part a and part b benefits are received |
| medigap supplements original Medicare |
| medicare advantage and medigap are not used together |
the 2026 starting point
| cost | 2026 information |
|---|---|
| standard part b premium | 202.90 dollars each month for most people |
| part b deductible | 283 dollars |
| part d drug out of pocket limit | 2100 dollars |
| medicare advantage in network limit | up to 9250 dollars for part a and part b services |
| medicare advantage combined limit | up to 13900 dollars for plans with out of network benefits |
The part b premium applies to both choices
A plan with a zero dollar premium does not remove the part b premium
Higher income beneficiaries may pay more
Late enrollment penalties may increase the amount
Plan premiums do not count toward the medicare advantage medical out of pocket limit
Part d drug costs do not count toward the medicare advantage medical out of pocket limit
| medicare and you 2026 |
| medicare plan compare |
medicare advantage plans
| feature | structure |
|---|---|
| monthly plan premium | often zero dollars or a separate plan premium |
| part b premium | continues |
| drug coverage | usually included |
| doctors | network rules may apply |
| specialists | referrals may apply |
| services | prior authorization may apply |
| medical limit | plan yearly limit |
| extra benefits | may include dental vision hearing fitness rides or over the counter items |
A medicare advantage plan can provide a lower monthly premium
The plan may use
| health maintenance organization rules |
| preferred provider organization rules |
| primary care provider rules |
| network provider rules |
| referral rules |
| prior authorization rules |
| formulary rules |
The plan document controls the cost
| service | possible plan cost |
|---|---|
| primary care visit | copayment |
| specialist visit | copayment |
| hospital admission | daily copayment |
| outpatient procedure | copayment or coinsurance |
| skilled nursing facility | daily cost after plan rules |
| emergency care | plan cost sharing |
| prescription drugs | formulary tier cost |
The yearly limit protects against unlimited covered medical cost sharing
The yearly limit may still be several thousand dollars
The limit applies to covered part a and part b services
The limit does not include every health expense
| noncovered services |
| some out of network services |
| plan premiums |
| part b premiums |
| part d drug cost rules |
medigap
| feature | structure |
|---|---|
| primary coverage | original Medicare |
| supplement role | pays certain Medicare cost gaps |
| monthly premium | separate private insurance premium |
| drug coverage | separate part d plan usually required |
| provider choice | any provider that accepts Medicare |
| network requirement | generally no plan network |
| referrals | generally no referral requirement |
| medical cost sharing | lower with broader plans |
Plan G is one common medigap option
For people new to Medicare on or after January 1 2020 Plan G does not pay the part b deductible
After the part b deductible is paid Plan G generally pays the remaining Medicare approved part a and part b cost sharing covered by the policy
Plan G does not pay for everything
| routine dental care |
| routine vision care |
| hearing aids |
| long term care |
| private duty nursing |
| most prescription drugs |
Medigap prices vary by
| state |
| age |
| insurance company |
| pricing method |
| enrollment timing |
| medical underwriting |
| available discounts |
The same lettered plan has standardized benefits
The premium can differ between companies
The benefit design can differ between plan letters
| compare medigap plan benefits |
| choosing a medigap policy |
provider choice
| original medicare with medigap | medicare advantage |
|---|---|
| any provider that accepts Medicare | plan network usually applies |
| nationwide access for Medicare providers | service area applies |
| specialist access generally without referral | referral may apply |
| prior authorization generally not used by original Medicare | prior authorization may apply |
Provider choice becomes more important when
| a current doctor is important |
| treatment is received in another state |
| travel is frequent |
| a specialist is needed |
| a hospital system is preferred |
| a provider may leave a plan network |
A doctor accepting Medicare does not automatically mean the doctor is in a specific medicare advantage network
Provider participation should be checked before enrollment
prescription drugs
| medicare advantage | medigap |
|---|---|
| part d usually included | separate part d plan |
| one plan may manage medical and drug coverage | medical and drug plans may be separate |
| formulary applies | formulary applies |
| drug costs vary by tier | drug costs vary by plan |
| 2100 dollar part d limit in 2026 | 2100 dollar part d limit in 2026 |
The prescription list should be checked before enrollment
The pharmacy network should be checked before enrollment
The drug dosage should be checked before enrollment
A drug that is covered by one plan may have different cost sharing under another plan
| current prescriptions |
| preferred pharmacy |
| mail order pharmacy |
| deductible |
| drug tier |
| prior authorization |
which choice can cost less
| situation | possible lower cost direction |
|---|---|
| low medical use | medicare advantage monthly premium may be lower |
| frequent specialist care | medigap may reduce repeated cost sharing |
| planned surgery | total plan cost comparison required |
| chronic condition | compare copayments networks and maximum limit |
| frequent travel | original Medicare with medigap may offer broader access |
| limited income | Medicare Savings Programs Medicaid and Extra Help may change the result |
| expensive prescriptions | compare the full formulary cost |
A simple premium comparison is incomplete
| annual cost review | |
|---|---|
| part b premiums | |
| plan premiums | |
| medigap premiums | |
| part d premiums | |
| deductibles | |
| primary care costs | |
| specialist costs | |
| hospital costs | |
| prescription costs | |
| dental costs | |
| vision costs | |
| hearing costs | |
| travel costs | |
| expected out of pocket limit | |
The lower annual estimate is not guaranteed
The estimate changes when health needs change
The estimate changes when plans change
The estimate changes when providers leave networks
enrollment timing
Medicare Government-Affiliation Disclaimer: Holmes Health, Wealth & Business is not connected with or endorsed by the U.S. government or the federal Medicare program.
| period | information |
|---|---|
| initial enrollment period | first Medicare enrollment opportunity |
| medigap open enrollment | one time six month period beginning with part b at age 65 or older |
| annual election period | October 15 through December 7 |
| medicare advantage open enrollment | January 1 through March 31 for people already in medicare advantage |
| special enrollment period | available in qualifying situations |
Medigap open enrollment is not an annual event
Outside that period
| medical underwriting may apply |
| prices may be higher |
| choices may be limited |
| coverage may be denied in some situations |
| state rules may provide additional rights |
Switching from medigap to medicare advantage can affect future medigap access
Returning to original Medicare does not always guarantee the same medigap policy
The timing should be reviewed before a policy is canceled
the practical comparison
| medicare advantage plans |
| lower fixed premium potential |
| bundled medical and drug coverage |
| extra benefits |
| network rules |
| plan cost sharing |
| yearly medical limit |
| medicare supplement plans |
| higher fixed premium potential |
| original Medicare structure |
| separate drug coverage |
| broader provider access |
| lower covered medical cost sharing |
| fewer routine extra benefits |
the working answer
| question | working answer |
|---|---|
| which plan has the lowest monthly premium | often medicare advantage |
| which plan may provide broader provider access | original Medicare with medigap |
| which plan may provide more predictable covered medical bills | broader medigap plan |
| which plan may include extra benefits | often medicare advantage |
| which plan protects against unlimited Medicare Advantage medical cost sharing | both systems have different protections |
| which plan saves more | depends on the complete personal comparison |
The comparison should include
| doctors |
| hospitals |
| prescriptions |
| travel |
| health conditions |
| expected care |
| budget |
| enrollment rights |
| state |
| future flexibility |
Josh Holmes can review the available Medicare choices and compare the structure of medicare advantage plans and medicare supplement plans
| request a quote |
| Medicare government links |
| Holmes Health Wealth and Business |