By the Kryder Cares Data Desk · Reviewed by Kris Kryder, licensed agent · Updated
Key points
- Medicare Advantage: one plan, often with drug coverage, a network and a yearly out-of-pocket maximum.
- Medigap: works with Original Medicare; add a separate Part D plan for drugs.
- Your 6-month Medigap Open Enrollment Period is the one time you can buy any policy regardless of health.
- Switching from Medicare Advantage back to Medigap later may mean medical questions.
Two different ways to get your Medicare
Once you have Part A and Part B, you choose how to receive them. Original Medicare is run by the federal government; you can add a Medicare Supplement (Medigap) policy from a private insurer to help pay your share, plus a stand-alone Part D drug plan. Medicare Advantage (Part C) is an all-in-one plan from a private insurer approved by Medicare that covers everything Parts A and B cover, and usually drugs too.
You can’t have both at once. CMS is plain about it: you can’t buy Medigap while you’re in a Medicare Advantage plan unless you’re switching back to Original Medicare, and Medigap can’t pay Medicare Advantage copays, deductibles or premiums.
| Original Medicare + Medigap | Medicare Advantage | |
|---|---|---|
| Doctors and hospitals | Any provider in the U.S. that accepts Medicare | Usually a network (HMO or PPO); PPOs cover out-of-network care at a higher cost |
| Monthly premium | Part B + Medigap premium + Part D premium | Part B + the plan’s premium (some plans have a $0 plan premium) |
| Costs when you get care | Low or none, depending on the Medigap plan letter | Copays and coinsurance up to the plan’s yearly maximum |
| Yearly out-of-pocket cap | None in Original Medicare; Medigap fills the gaps | Yes, set by each plan under a CMS ceiling |
| Drug coverage | Separate Part D plan | Usually included |
| Referrals and prior authorization | Generally not required by Medicare | HMOs usually need referrals; prior authorization is common |
| Extra benefits | Not included | Many plans include some dental, vision or hearing |
How Medigap works
Medigap policies are standardized: a Plan G from one company has the same basic benefits as a Plan G from another, in every state except Massachusetts, Minnesota and Wisconsin. Price and the company’s service are what differ. Most states offer 10 plan letters — A–D, F, G and K–N.
Not everyone can buy Plans C and F — it depends on when you first became eligible, and CMS counts anyone who turned 65 or first became eligible on or after January 1, 2020 as new to Medicare. Plans differ in which gaps they pay. Plan N, for example, pays 100% of Part B coinsurance, but you may pay up to $20 for some office visits and up to $50 for an emergency room visit that doesn’t lead to an admission. A high-deductible Plan G trades a lower premium for a deductible of $2,950 in 2026 and $3,050 in 2027.
Medigap doesn’t include drug coverage, so you’ll want a Part D plan alongside it. See the Medicare Supplement page for the companies Kris represents in Ohio.
How Medicare Advantage works
Medicare Advantage plans bundle hospital, medical and usually drug coverage into one card. Most are HMOs (you generally must use network providers except for emergencies) or PPOs (you can go out of network but pay more). Every plan has a yearly limit on what you pay for covered Medicare services (sometimes with separate in-network and out-of-network limits). Once you reach it, you pay nothing for covered services for the rest of the year. CMS sets a ceiling each year and each plan sets its own limit.
Plans change their premiums, networks, drug lists and extras every January, so the plan that fit this year may not fit next year. Expect prior authorization for some services. Kris’s Medicare Advantage page lists the carriers she represents.
The switching rule that changes the decision
Your Medigap Open Enrollment Period — 6 months starting the first month you have Part B and are 65 or older — is the one time federal law guarantees you can buy any Medigap policy sold in your area without health questions or higher prices for health reasons. After that, in most situations, companies can use medical underwriting and may decline you.
That makes the first decision weightier than it looks. You can usually switch from Medigap to Medicare Advantage during Open Enrollment each fall, but moving back from Medicare Advantage to Medigap later may mean answering health questions. A few situations create guaranteed-issue rights. One is a “trial right”: if you drop Medigap to join Medicare Advantage for the first time, you have a single 12-month period to get your Medigap policy back if the same company still sells it. State rules can add more, so ask before you switch.
Questions to ask yourself
There isn’t a right answer for everyone. These questions usually point the way:
- Do you split the year between Ohio and another state, like Florida? Networks are local; Original Medicare works nationwide.
- Do you have specialists or a hospital system you won’t give up? Check whether they’re in each plan’s network.
- Would you rather pay a steady monthly premium, or pay less monthly and more when you use care?
- How healthy are you now, and how would you feel if you couldn’t buy Medigap later?
- Are dental, vision or hearing extras important, or do you prefer a separate plan for them?
How Kris helps
Kris lays out Medigap and Medicare Advantage options from the companies she represents side by side, checks your doctors and prescriptions, and explains what each choice costs over a year. Her longer article on Medigap vs. Medicare Advantage in Ohio adds local detail. Book a no-cost meeting whenever you’re ready.
Your next step
Have questions about your own situation? Contact Kris or schedule a no-cost meeting. You can also read more about Medicare Advantage and Medicare Supplement (Medigap).
Sources
- CMS — Compare Original Medicare & Medicare Advantage
- CMS — Get Medigap basics
- CMS — Learn how Medigap works
- CMS — Compare Medigap plan benefits
- CMS — Get ready to buy a Medigap policy
- CMS — Compare types of Medicare Advantage Plans
- CMS — CY 2027 Medigap high-deductible options F, J and G (PDF)
We do not offer every plan available in your area. Currently we represent 14 organizations which offer 119 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. This is a proprietary website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at www.medicare.gov.
This guide is general education, not a recommendation for any specific plan or policy. Figures were current as of October 19, 2026; plan details and government amounts change every year.