Medigap vs. Medicare Advantage
Which Is Right for Your Parent? A choice that’s less about insurance than about how much risk you’re willing to carry…
By Alexander Nury, Co-Author, Survival Guide to Caring for Aging Parents
The short answer: Medigap costs more every month but caps your parent’s financial exposure almost completely; Medicare Advantage usually costs little to nothing extra per month but can expose your parent to out-of-pocket maximums as high as $9,500 in a bad health year. Neither is objectively better — the right choice depends on your parent’s health, risk tolerance, budget, and location.
Why This Decision Feels So Confusing
When I sat down with my mother’s Medicare and Medicaid paperwork, I had to read and learn all about which acronym was which. Part A, Part B, Part C, Part D, Medigap, Medicare Advantage, IRMAA. It read like an alphabet soup designed by someone who has never had to explain it to a tired adult child at eleven at night.
What’s the Real Difference Between Medigap and Medicare Advantage?
In Chapter Five of our book, Survival Guide to Caring for Aging Parents, we use a metaphor that finally made this click for me, so I’ll borrow it here: a fixed-price menu versus an à la carte one. Original Medicare, the kind you pair with a Medigap policy, is à la carte — you pick Part A for hospital stays, Part B for doctor visits, add a Medigap plan to cover most of what’s left, and a Part D plan for prescriptions. Medicare Advantage is the prix fixe option: one plan, one card, administered by a private insurer instead of the federal government directly, appetizer through dessert. No substitutions.
Neither menu is necessarily better. They’re built for different appetites, different risk tolerances, and different geographic areas. These differences matter most in the moment you least want to be thinking about insurance categories: a hospitalization, a diagnosis, a 100-day rehab stay nobody saw coming.
How Much Do Medigap and Medicare Advantage Actually Cost?
Strip away the acronyms, and the decision comes down to one trade-off: monthly premium versus financial exposure if something goes wrong.
Medigap costs more up front. Everyone pays the standard Part B premium — $202.90 a month in 2026 — plus a Medigap supplement on top, anywhere from roughly $125 a month (not typical) for a newly eligible 65-year-old on a leaner plan up to around $800 a month for a richer plan in an expensive state at an older age. In return, you get a network that includes essentially any doctor in the country who accepts Medicare, and out-of-pocket costs that, in a bad year, often stay under a few hundred dollars.
Medicare Advantage flips that arrangement. About three out of four enrollees pay no premium beyond the standard Part B amount — on paper, the better deal. The catch is the ceiling, not the floor: a bad health year on Medicare Advantage can mean an out-of-pocket maximum as high as $9,250–$9,500 in-network, and up to roughly $13,900 if out-of-network care gets involved, plus the administrative nightmare of network restrictions and referral requirements. Many doctors and hospitals are also dropping Medicare Advantage plans, which means fewer care options for the enrollee.
In other words, a Medigap path might run your parent around $500 (not including Medicare Part B) or more a month all-in with very little surprise exposure. A Medicare Advantage path might run closer to $200 a month (not including Medicare Part B) in, with the real cost sitting in reserve — waiting to see whether this is the year your parent needs it.
Can You Switch Between Medigap and Medicare Advantage Later?
This isn’t a choice you get to revisit every year with a clean slate. If your parent starts on Medigap and later decides to try Medicare Advantage, that’s allowed. But go the other direction — from Medicare Advantage back to Medigap after more than a year on it — and insurers are generally entitled to medically underwrite the application. If your parent has developed a health condition in the meantime, which is more likely with each passing year, they can be charged significantly more for the same coverage they could have gotten cheaply at the start, or in some states, they can be denied outright.
There’s a narrow safety net in your first year on Medicare Advantage — sometimes called a “trial right” — that lets you switch back to Medigap without medical underwriting if the plan turns out to be a poor fit. After that window closes, you’re largely locked into the choice you made. About ten states also offer a “birthday rule,” letting residents switch to an equal or lesser Medigap plan during their birthday month without underwriting — but that’s the exception, not something to count on if your parent lives elsewhere.
The decision that looks reversible in year one becomes close to permanent by year two. That’s worth thinking about before you default to whichever option has the lower number on it today.
“One Medicare Consultant advised us that it was a ‘crap shoot.’ He said, ‘If you think you are healthy and won’t need any unusual medical care, then go with Medicare Advantage and save money. If you think you might have any surprise diagnoses or might need medical procedures, surgeries, or other therapies, then go with a Medicare Supplement (Medigap).’” — Chapter 5, Survival Guide to Caring for Aging Parents
How Do I Decide Which Is Right for My Parent?
I’m not a financial advisor, and none of this is a recommendation for your specific situation. Medigap and Medicare Advantage costs vary widely by state, carrier, age, and your parent’s existing health, so treat the figures above as a starting range, not a quote. A free, independent Medicare consultant — one who isn’t tied to a single insurance company — can run actual numbers for your parent’s zip code and health history, and Medicare.gov’s plan comparison tool is worth an evening of your time before open enrollment closes. You’ll also need to weigh your parent’s health, family history, in-network providers, and proximity to preferred doctors and hospitals.
What finally settled this for me wasn’t a chart, though I’d encourage you to build one (or ask your agent to) anyway: premiums, plausible out-of-pocket scenarios, whether your parent’s current doctors are even in a given network. It was accepting that no version of this removes the gamble entirely. You’re choosing which kind of uncertainty you can live with — a higher bill every month, or a higher bill in a bad year — and doing it on behalf of someone who may not fully grasp the stakes of the choice being made for them. Give it the time to analyze the options that it deserves.