Medicare Advantage vs. Medigap Which One is Right for You?

Diane Andree
Jul 24
3 min read

If trying to understand Medicare feels confusing, you’re not alone. With so many terms, plans, and costs to compare, it’s hard to know where to start.

But this isn’t a game — it’s your health, your money, and your future. And if you’re on Long Island, you’re in luck. Let’s solve this puzzle together: Medicare Advantage vs. Medigap — what’s the difference, and which one is right for you?

Understanding Your Options

Medicare Advantage (Part C)These are all-in-one plans offered by private insurance companies approved by Medicare, and they typically combine: - Part A (hospital) - Part B (doctor) - Part D (prescription drugs) Many also throw in extra perks like dental, vision, hearing.

Some carriers offer HMO plans. These plans only allow you to receive healthcare services from providers that are in-network, meaning, providers that are contracted with the HMO plan and some still require referrals. PPO plans offer more flexibility, no referrals needed, allowing nationwide usage, even outside emergencies because they include out-of-network benefits. This means that if you need healthcare services from a provider that is not contracted with the plan, you can still use them, but at a higher out-of-pocket cost. In addition, many insurance carriers offer state reciprocity, which lets you see doctors in-network even when traveling to other states, if the insurance carrier has locations in that state.

✅ Great if you want lower or $0 premiums and extra benefits

⚠️ What to watch for:

- Limited provider networks in HMO plans- Costs vary depending on usage

- Prior authorizations may be required 🔔Starting in 2026, Original Medicare will also begin using prior authorizations for certain services.

Medigap (Medicare Supplement Plans)These are sold by private insurers to “fill in the gaps” that Original Medicare leaves behind — like copays, coinsurance, and deductibles.

· No networks – see any doctor who accepts Medicare, anywhere in the U.S.

· You’ll need a separate Part D plan for prescription drugs

· Fewer surprises, but higher monthly premiums

💸 Big news for 2026:UnitedHealthcare has applied for substantial premium increases in New York. Here are a few examples:

Plan	2025 Monthly Rate	Proposed 2026 Rate	% Increase
G	$327.75	$385.50	17.6%
N	$262.25	$309.00	17.8%
F	$445.50	$526.00	18.1%

📌 Read more here: USA Today: Medicare Supplement Premium Hikes

🔔 With these costs, you could pay $4,000–$5,000 a year upfront — even if you don’t end up using the coverage.

Side-by-Side Comparison

Feature	Medicare Advantage	Medigap (Supplement)
Includes Drug Coverage?	Usually Yes	No (need Part D)
Network Restrictions?	Some (HMO/PPO)	None
Monthly Premiums	Often $0–$40	$250+ and rising
Doctor Referrals?	Not with PPOs	Not needed
Travel Friendly?	Emergencies + reciprocity	Nationwide
Prior Authorizations?	Yes	Not yet (until 2026)
Extra Benefits?	Yes — dental, vision, hearing	No

How to Decide

· Do I travel often or spend time in another state?

· Are my current doctors in a plan’s network?

· Would I rather pay more each month and have fewer bills later?

· Can I afford Medigap premiums, even if I rarely use it?

· Do I want extras like dental, hearing, vision?

What Long Island Seniors Should Know

· PPO Medicare Advantage plans are popular and widely accepted across Nassau and Suffolk Counties

· Guaranteed issue rules in New York allow you to switch Medigap plans any time — no health questions

· Medigap premiums are going up in 2026

· For many seniors, Medicare Advantage is a more affordable option that includes perks they enjoy and use

➡️ And yes, we know Medicare Advantage gets a bad rap. But here’s the reality: millions of people love their plans. Especially when they’re well-matched to their lifestyle and their doctors and medications are covered.

Clearing Up Common Misunderstandings

· “Medicare Advantage replaces Medicare.” ❌ Not true — you’re still enrolled in Medicare Parts A & B, but it takes over your care.

· “$0 premium means free.” ❌ While it’s true that the plan has no premium cost, you will have co-pays and deductibles when you receive some healthcare services.

· “Medigap includes dental and vision.” ❌ Nope. Only Medicare Advantage does.

· “I can’t switch plans once I choose.” ❌ In New York, you can!

Final Thoughts

You’re probably buried in Medicare mailers, bombarded with TV commercials, and getting more calls than your high school reunion group chat. It’s a lot.

And when you’re trying to solve the puzzle of Medicare — with all its missing letters and options — it helps to have someone who knows what the board really says.