Health Insurance for Seniors: Medigap vs. Medicare Advantage

For Florida seniors approaching Medicare eligibility, one of the most consequential health insurance decisions you will face is how to supplement Original Medicare. The two primary paths — Medigap (Medicare Supplement Insurance) and Medicare Advantage — both address the gaps in Original Medicare, but they do so in fundamentally different ways. Choosing the right path can affect your health care access, your out-of-pocket costs, and your financial security for years to come.

Original Medicare (Parts A and B) covers a broad range of health care services, but it leaves significant gaps:

• No out-of-pocket maximum: You could theoretically pay unlimited costs in a catastrophic illness year
• Part A deductible: $1,676 per benefit period in 2026 (not per year — per hospital stay)
• Part B coinsurance: You pay 20% of all Part B costs after your deductible, with no cap
• No prescription drug coverage: Part D must be purchased separately
• No dental, vision, or hearing coverage

Most Medicare beneficiaries address these gaps with either a Medigap policy (which supplements Original Medicare) or a Medicare Advantage plan (which replaces Original Medicare).

Medigap, also called Medicare Supplement Insurance, is private insurance that works alongside Original Medicare to cover some or all of the costs that Medicare does not pay — including deductibles, coinsurance, and copays.

Medigap plans are standardized by the federal government. In Florida, plans are identified by letters (Plan A, Plan B, Plan G, Plan N, etc.), and every insurer offering the same plan letter must provide identical benefits. The only difference between insurers is the premium they charge.

The most popular Medigap plans for new enrollees in Florida are:

Plan G: Covers nearly everything Original Medicare does not, except the Part B deductible ($257 in 2026). After paying the annual Part B deductible, you have essentially no out-of-pocket costs for covered services. Plan G is the most comprehensive option available to new Medicare enrollees.

Plan N: Similar to Plan G but with modest copays — up to $20 for office visits and up to $50 for emergency room visits that do not result in inpatient admission. Plan N premiums are lower than Plan G, making it a good choice for relatively healthy seniors who want strong coverage at a lower cost.

Plan A: The most basic Medigap plan, covering only core benefits. Rarely the best value for most beneficiaries.

Note: Plan F — historically the most popular Medigap plan — is no longer available to beneficiaries who became eligible for Medicare on or after January 1, 2020.

Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers approved by Medicare. Instead of using Original Medicare directly, you receive your Medicare benefits through the Advantage plan.

Medicare Advantage plans must cover everything Original Medicare covers, and most include additional benefits such as prescription drug coverage (Part D), dental, vision, hearing, fitness memberships, and transportation.

Medicare Advantage plans are typically structured as HMOs or PPOs with provider networks, and many are available for $0 beyond the standard Part B premium.

Medigap: Higher monthly premiums (often $100–$300+ per month depending on age and plan), but very low or zero out-of-pocket costs when you use care. Your costs are predictable.

Medicare Advantage: Often $0 monthly premium beyond Part B, but you pay copays, coinsurance, and deductibles when you use care. You have an annual out-of-pocket maximum (up to $9,350 in-network in 2026), but costs can be unpredictable.

Medigap: You can see any doctor or specialist in the country who accepts Medicare — no networks, no referrals, no prior authorizations for most services. This is the most flexible option available.

Medicare Advantage: You must generally use the plan's network of providers. HMO plans require referrals for specialists; PPO plans allow out-of-network care at higher cost. Prior authorization is often required for certain services.

Medigap: Does not include prescription drug coverage. You must purchase a separate Part D plan.

Medicare Advantage: Most plans include Part D drug coverage, bundling medical and prescription benefits in one plan.

Medigap: Covers only the gaps in Original Medicare — no dental, vision, hearing, or fitness benefits.

Medicare Advantage: Most plans include dental, vision, hearing, fitness memberships, and other extras that Medigap does not offer.

Medigap: Works anywhere in the country that accepts Medicare — ideal for snowbirds, frequent travelers, or those who split time between states.

Medicare Advantage: Coverage is generally limited to your plan's service area. Out-of-area coverage is typically limited to emergencies.

Medigap: Your benefits are standardized and do not change year to year (though premiums may increase with age). Your coverage is highly predictable.

Medicare Advantage: Plans can change their premiums, networks, formularies, and extra benefits each year. You may need to re-evaluate your plan annually.

One of the most important — and least understood — aspects of this decision is what happens if you want to switch later.

If you enroll in Medigap during your Initial Enrollment Period (the six months beginning the month you turn 65 and enroll in Part B), you have guaranteed issue rights — insurers must sell you any Medigap plan at standard rates regardless of your health.

If you later want to switch from Medicare Advantage back to Original Medicare with a Medigap policy, you may face medical underwriting in most states. In Florida, Medigap insurers can charge higher premiums or deny coverage based on your health history if you are outside your initial enrollment window.

This means that if you enroll in Medicare Advantage and later develop a serious health condition, you may find it difficult or impossible to switch to a Medigap plan with comprehensive coverage. This asymmetry makes the initial decision especially important.

Medigap tends to be the better choice if you:

• Have significant or complex health conditions requiring frequent specialist care
• Travel frequently or spend time in multiple states
• Want maximum provider flexibility with no network restrictions
• Prefer predictable, stable costs even if monthly premiums are higher
• Are willing to purchase a separate Part D plan for prescriptions

Medicare Advantage tends to be the better choice if you:

• Are generally healthy and use a predictable set of local providers
• Want to minimize monthly premiums
• Value extra benefits like dental, vision, hearing, and fitness programs
• Are comfortable with network-based care and prior authorization requirements
• Want prescription drug coverage bundled with your medical plan

Florida is one of the most competitive Medicare markets in the country, with dozens of Medicare Advantage plans available in most counties and a robust Medigap market. This competition generally benefits Florida seniors — more plan options, lower premiums, and richer extra benefits than in many other states.

However, Florida's large retiree population also means high demand for specialists and potential network access challenges in some areas. Verifying that your preferred providers are in-network before enrolling in a Medicare Advantage plan is essential.

Choosing between Medigap and Medicare Advantage is one of the most important financial decisions you will make in retirement. At All Horizon Financial Services, our licensed Medicare advisors help West Palm Beach and South Florida seniors compare every available option — at no cost to you.

Call us at 561-688-7300 or 561-301-5274 to schedule your free Medicare consultation today. We will help you find the coverage that protects your health and your financial security in retirement.