Once a client is on Original Medicare (Parts A & B), the cost-sharing gaps are still there — the 20% Part B coinsurance, the deductibles, and no cap on what they could spend in a bad year. There are two ways to handle that, and a client generally can’t do both: add a Medicare Supplement (Medigap) policy alongside Original Medicare, or switch to a Medicare Advantage plan that replaces Original Medicare’s coverage. Have this comparison before any plan shopping.
| Medigap (Supplement) | Medicare Advantage | |
|---|---|---|
| What it does | Pays the out-of-pocket gaps left by Original Medicare — deductibles and coinsurance | Replaces Original Medicare; delivers A & B benefits (and usually Part D) through a private plan |
| Relationship to Original Medicare | Works alongside it — client keeps Parts A & B | Replaces it — client gets A & B benefits through the plan |
| Monthly premium | Plan premium on top of the Part B premium | Often $0 plan premium (Part B premium still applies) |
| Provider access | Any doctor or hospital nationwide that accepts Medicare | Plan network, usually regional; may need referrals |
| Drug coverage | None — buy a standalone Part D plan separately | Usually bundled in (MAPD) |
| Out-of-pocket cap | None on its own | Required annual MOOP cap |
| Extra benefits | Medical only — no dental, vision, hearing, OTC | Often includes dental, vision, hearing, OTC, transportation |
When each is the better fit
Medigap tends to fit a client who
- Travels or splits time between states and wants nationwide provider access
- Sees multiple specialists and values no referrals and no network
- Wants predictable cost-sharing (Plan G pays virtually everything after the Part B deductible)
- Can afford the monthly premium and prioritizes low hassle at the doctor
Medicare Advantage tends to fit a client who
- Is on a tight monthly budget and wants a $0 plan premium
- Wants bundled dental, vision, hearing, or OTC benefits
- Is comfortable with a network and possibly referrals
- Wants one plan covering medical and drugs together
Practice scenarios
Plan G plus nationwide, no-network access fits his travel and his two specialists. The dental benefit probably doesn’t outweigh losing that freedom — and if he dislikes MA later, getting Medigap Plan G back may require medical underwriting. Confirm his providers would be in any MA network first, but the honest default here is that his current setup is already a strong fit.
Her needs line up with what MA bundles — $0 premium, dental and hearing extras, a MOOP cap, and one plan for medical + drugs. But confirm her primary doctor is in-network and that her prescriptions are on the formulary before recommending. The do-not-engage hard-stop rules still apply: confirm there’s no active employer coverage first.
Dropping Medigap to join MA is allowed, but getting that Medigap policy back later usually requires medical underwriting outside of guaranteed-issue windows — so it may not be available, or may cost far more. Don’t frame this as a reversible “try it and switch back” move. Lay out the trade-off honestly, confirm whether he’s in any guaranteed-issue window, and document the conversation.