Your mom is turning 65, and the mail has started. Some letters push Medicare Advantage plans with extra benefits. Others pitch Medicare Supplement policies. Friends at church swear by one or the other. Your mom asks you which is better, and the honest answer is that it depends on her doctors, her health, how she travels and how she feels about paying more up front versus risking more later. This guide walks through the real differences so you can help her decide with confidence.
This guide uses Medicare.gov and its Medigap guidance. We don't list premiums or plan costs, because they vary by state, plan and year. For personal, unbiased help, contact your parent's State Health Insurance Assistance Program (SHIP)3.
The basics: two different paths
Original Medicare is Part A (hospital) and Part B (medical) from the federal government. It covers a lot, but leaves your parent with deductibles, coinsurance and copayments, and it has no yearly cap on out-of-pocket costs1. Most people also add a separate Part D drug plan.
Medigap, also called Medicare Supplement Insurance, is private insurance that helps pay some of the remaining health care costs for services Original Medicare covers, like copayments, coinsurance and deductibles4. To buy it, your parent must have both Part A and Part B4. Medigap generally doesn't include drug coverage, so it's paired with a Part D plan.
Medicare Advantage (Part C) is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for health and drug coverage1. Most plans include drug coverage, and many offer extra benefits Original Medicare doesn't cover, such as some vision, hearing and dental services1.
The key point: Medigap only works with Original Medicare. If your parent joins a Medicare Advantage plan, a Medigap policy can't pay for anything1.
Side by side: how they differ
- Doctor and hospital choice. Original Medicare with Medigap: any doctor or hospital in the U.S. that takes Medicare. Medicare Advantage: usually a network, and out-of-network care may cost more or not be covered except emergencies1.
- Seeing specialists. Original Medicare generally doesn't require approval to see a specialist. Some Medicare Advantage plans do1.
- Prior authorization. Medicare Advantage plans may require approval in advance before covering certain services; Original Medicare rarely does1.
- Yearly cost limit. Medicare Advantage plans have a yearly limit on what your parent pays for covered Part A and B services. Original Medicare has no limit, which is why many people add Medigap1.
- Monthly costs vs. costs when sick. Medigap usually means a separate premium in exchange for fewer surprises when care is needed. Medicare Advantage often has lower monthly premiums but copays and coinsurance as services are used.
- Drug coverage. Medigap: add a separate Part D plan. Medicare Advantage: usually included1.
- Extra benefits. Some Medicare Advantage plans include dental, vision or hearing benefits1. Medigap does not add these.
- Travel. Original Medicare generally doesn't cover care outside the U.S., but some Medigap policies cover emergency care abroad1. Medicare Advantage coverage away from home depends on the plan.
The Medigap timing trap
This is the part families most often learn too late. Your parent gets a one-time, six-month Medigap Open Enrollment Period that starts the month they're 65 or older and enrolled in Part B2. During that window, insurers can't refuse to sell them any policy they offer or charge more because of health problems2.
After the window closes, insurers in most states can use medical underwriting. That means they can ask health questions and may refuse a policy or charge more, unless your parent has a guaranteed issue right2. Some states give extra rights beyond federal law, so ask the SHIP or state insurance department.
Why it matters for this choice: a person who starts on Medicare Advantage and later, after a serious diagnosis, wants Original Medicare plus Medigap may not be able to buy a Medigap policy. Choosing Medicare Advantage at 65 is not always a permanent choice, but it can be hard to undo.
Guaranteed issue rights and trial rights
Federal law gives guaranteed issue rights in certain situations, such as when a Medicare Advantage plan leaves the area or your parent's employer coverage ends. In those cases insurers must sell certain Medigap policies and can't charge more for past or present health problems5.
Timing matters: in many cases your parent must apply for Medigap within 63 days after the other coverage ends to keep these rights5. Keep any letters about coverage ending, since they serve as proof.
There is also a trial right for people who try Medicare Advantage. If your parent joined a Medicare Advantage plan when first eligible at 65 and changes their mind within the first year, they can switch back to Original Medicare and buy a Medigap policy5. A similar right applies to someone who dropped Medigap to try Medicare Advantage for the first time. Once that year passes, those rights end.
If your parent switches Medigap policies, they get a 30-day free look period to decide whether to keep the new one, paying both premiums for that month5. Don't cancel the old policy until the new one is in place. If your parent drops Medigap entirely, they may not be able to get it back later5.
When Medigap may fit better
- Your parent wants to keep specific doctors or specialty centers. Original Medicare is accepted widely, so there's less risk a key doctor is out of network1.
- Your parent has serious or ongoing health conditions. Predictable costs and fewer approval steps can mean less stress during treatment.
- Your parent splits time between two states or travels a lot. Original Medicare works across the U.S., and some Medigap policies help with emergencies abroad1.
- Your parent is in the Medigap window now. This is the best chance to buy without health questions2.
When Medicare Advantage may fit better
- Your parent's doctors and hospitals are in a plan's network. Check each one by name before enrolling.
- Lower monthly costs matter most. Many plans have low premiums, though your parent pays as they use services.
- Your parent wants extra benefits in one card. Some plans include drug, dental, vision and hearing coverage together1.
- Your parent values a yearly cost cap. Medicare Advantage plans limit yearly out-of-pocket costs for covered services1.
How to help your parent decide
- List doctors, hospitals and medicines. Include specialists and any treatment center your parent may need.
- Check the Medigap window. Find the month Part B started and whether the six months have passed2.
- Compare plans in Medicare's plan finder. Add every medicine for an accurate estimate6.
- Check networks by name. Call doctors' offices and ask whether they'll be in network next year.
- Think through a bad year. Ask what your parent would pay with a hospital stay, surgery or cancer treatment under each option.
- Talk to a SHIP counselor. They give free, unbiased help and aren't tied to any insurer3.
- Decide together and write it down. Note why your parent chose what they did, so next fall's review is easier.
When your parent can switch
Your parent can move between Original Medicare and Medicare Advantage during Open Enrollment, October 15 to December 7, with changes starting January 16. People already in Medicare Advantage can also make one change from January 1 to March 316. Medigap can be bought any time, but outside the Medigap window and guaranteed issue situations, insurers may say no. Read our Medicare Open Enrollment guide for the yearly checklist.
If your parent may move to senior living
Think ahead about where your parent may live in a few years. If a move to assisted living or memory care near you is possible, a Medicare Advantage network in their current county may not cover doctors in the new area. Moving out of a plan's service area does give a Special Enrollment Period to change plans, but it doesn't guarantee a Medigap policy unless a guaranteed issue right applies5. Ask any community you tour which pharmacies and visiting doctors it uses. See assisted living medication management.
If you help from another city, set up a shared call to compare options together. Our guide to long-distance caregiving has more ideas for staying organized.
Questions to ask before choosing
- Are all of my parent's doctors and hospitals covered? Ask by name, for next year.
- What would a hospital stay cost under each option? Compare a bad year, not just a healthy one.
- Which services need prior authorization? Ask the plan for its list1.
- Is my parent still in the Medigap window or a trial period? This changes how easy it is to switch later5.
Help with costs
If money is tight, check whether your parent qualifies for a Medicare Savings Program, which helps with Medicare premiums and sometimes other costs, and Extra Help for drug costs. People with Medicaid usually have different options and should talk to a SHIP counselor before buying Medigap.
An example
Walter, 66, is in his first year of Medicare. He picked a Medicare Advantage plan at 65 for its low premium. This summer he was diagnosed with a heart condition, and his cardiologist isn't in the plan's network. His son calls a SHIP counselor, who explains Walter's trial right: because he joined Medicare Advantage when first eligible and is still in his first year, he can return to Original Medicare and buy a Medigap policy without health questions5. They add a Part D plan and keep his cardiologist. This is an illustration; your parent's best choice depends on their situation.
Helping without taking over
Plans usually need your parent's permission to talk with you. Ask your parent to name you as an authorized contact, or use a power of attorney if they have one. Watch for high-pressure sales calls, and never share a Medicare number with someone who calls out of the blue. See what to do if an elderly parent is scammed. For overall planning, see managing an elderly parent's finances.
