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Medigap vs. Medicare Advantage

Original Medicare often comes with high out-of-pocket costs. If you want more coverage than Original Medicare provides, you have two options. Either supplement with a Medigap plan or purchase a Medicare Advantage plan. Both plan types offer more coverage than Original Medicare. But understanding how the plans differ from each other is important, and choosing whether to go with a Medigap or Medicare Advantage plan is really a personal choice.

We recommend talking with a Highmark Personal advisor to find the plan that best fits your needs. But before you have that conversation, it may be helpful for you to understand the options.

Deciding between Medigap and Medicare Advantage

Here are a few simple questions to see if a Medigap or Medicare Advantage plan is right for you.

1. Do you prefer à la carte coverage or a package deal?

Medigap plans pay for the deductibles and coinsurance that come with Original Medicare. But you may need to purchase extra coverage for prescription drug and benefits not covered by Medicare such as dental or vision. Costs can add up but choosing each of your plans lets you personalize your coverage. Worried about doing it all yourself? Highmark has a number of options to make it easy for you, like Whole Health Balance, that bundle the added benefits of fitness memberships, dental, vision, and hearing aids into one convenient package. We also have separate prescription drug plans to choose from.

Medicare Advantage plans roll all your coverage into one plan, allowing you to make just one decision. Medicare Advantage plans also include extra services, like nurse case managers who can help you manage a chronic condition or support your wellness goals, and other wellness benefits. As your needs change, you’ll also have the flexibility to change your plan once a year without regard to your age or medical condition. Open enrollment takes place from Oct. 15 through Dec. 7.

2. What is your spending style?

Medigap and Medicare Advantage each use very different approaches to spending. Medigap plans typically have larger monthly premiums, but you’ll pay very little when you visit a provider. It is easy to budget for your health care with Medigap plans. You’ll know exactly how much you’ll be paying each month.

With a Medicare Advantage plan, monthly premiums are typically low. Premiums for each plan are the same for every person, regardless of age or health history. Since you’ll only pay for the health care you use, there will be considerable savings upfront. Yet you will be responsible for copayments and coinsurance, which can be unpredictable from month to month, depending on how often you see your providers. There is a cap on out-of-pocket spending, though most members do not reach that cap.

3. What are your provider needs?

Before deciding on a plan, you’ll want to consider the providers you see as well as your lifestyle. With Medigap, you’ll be free to visit any doctor or hospital in the country as long as they accept Medicare. This is a bonus if you travel a lot, or don’t want to concern yourself with whether your provider is in-network.

Medicare Advantage plans take advantage of a defined provider network, where plans partner with trusted doctors and hospitals to offer you high-quality services at a lower cost. Other larger carriers, like Highmark, may also cover costs for you to visit providers outside of your plan’s network. Seeing in-network providers is usually less expensive, but you may have preferred providers you want to see instead. Either way, be sure to check the plan’s provider directory and out-of-network benefits before choosing a Medicare Advantage plan to keep your costs to a minimum.

Consider your long-term needs

You’ll also want to consider your long-term needs when selecting a plan.

Many people who select a Medigap plan do so when they first become eligible for Medicare and stay with the same plan over time. This is because you are guaranteed to be accepted at the best rate when you first age into Medicare upon turning 65. After that, those who want to switch into a Medigap plan or make changes to their plan could result in higher rates or fewer coverage options based on age or new medical conditions.

With Medicare Advantage plans, you have the flexibility to change your plan coverage once a year, and without regard to your age or medical condition. Open enrollment takes place each year from Oct. 15 through Dec. 7.

The best choice is the plan that fits your lifestyle and budget needs. Both are good options, but it’s important to find the right fit for your unique preferences.

Talk to a licensed Medicare advisor

To enroll in a Highmark plan or learn more call
1-844-614-0343 (TTY users call 711)
8 a.m. - 8 p.m. ET, Monday to Friday
9 a.m. - 5 p.m. ET, Saturday 
Or visit our Reservations site


Talk to a licensed Medicare advisor

To enroll in a Highmark plan or learn more call
1-844-614-0343 (TTY users call 711)
8 a.m. - 8 p.m. ET, Monday to Friday
9 a.m. - 5 p.m. ET, Saturday
Or visit our Reservations site