How do These Two Choices Work?

Let’s start with the basics.

Medicare Supplement, or Medigap

Medigap works with Original Medicare. Original Medicare pays its part of your covered healthcare costs. Your Medigap plan can help pay some of the remaining costs, depending on the plan.

With Original Medicare and Medigap, you can generally see any doctor or hospital in the U.S. that accepts Medicare. You usually do not need a referral to see a specialist.

You normally pay a monthly premium for Medigap. Prescription drug coverage is usually separate, so you may also need a Part D plan.

Medicare Advantage

Medicare Advantage works differently. You get your Medicare Part A and Part B benefits through a private insurance plan approved by Medicare. Most Medicare Advantage plans also include prescription drug coverage.

Some plans offer extra benefits, such as dental, vision, or hearing coverage. The benefits are different from one plan to another.

One important rule is easy to remember: you cannot have a Medigap plan and Medicare Advantage at the same time.

What Will You Pay?

The monthly premium is only one part of the cost. With Medigap, you normally pay your Part B premium and a separate Medigap premium. Depending on your plan, Medigap can help pay some Medicare-covered costs, such as certain copayments and coinsurance. You will generally need separate Part D coverage for prescription medicines.

With Medicare Advantage, you still pay your Part B premium. Some plans have another monthly premium. Some have a $0 plan premium.

But a $0 plan premium does not mean all your healthcare costs are $0. You may pay a copay when you visit a doctor, use certain services, or fill a prescription. Medicare Advantage plans also have a yearly limit on covered out-of-pocket costs.

Before choosing a plan, look at what you may pay when you actually use your healthcare.

Can You Keep Your Doctors?

For many older adults, this is very important. With Original Medicare and Medigap, you can generally see any doctor or go to any hospital that accepts Medicare. You usually do not need a referral to see a specialist.

Medicare Advantage plans often have a network. This means you may need to use certain doctors and hospitals. Going outside the network may cost you more or may not be covered, depending on the plan. Some plans also require a referral or approval before you receive certain care.

Before you choose, check whether the plan includes:

Your regular doctor
Your specialists
Your preferred hospital
Your medicines
Your pharmacy

If you have a doctor you have known for years, make sure you can continue seeing them.

What Should You Check Before Choosing?

When comparing Medigap vs. Medicare Advantage in California, think about your own healthcare needs.

Use this simple checklist:

Doctors: Can I keep my doctors?
Hospitals: Can I use the hospital I prefer?
Medicines: Are my prescriptions covered?
Specialists: Can I see them when I need to?
Costs: What will I pay each month?
Doctor visits: What will I pay when I receive care?
Travel: What happens when I travel outside San Diego?
Extra benefits: Would dental, vision, or hearing benefits be useful to me?
Rules: Will I need referrals or approval for some care?

If you are thinking about Medigap, pay attention to timing. Your Medigap Open Enrollment Period generally starts when you are 65 or older and enrolled in Part B. It lasts six months. During this period, you have important protections when buying a Medigap policy. After that, your options may depend on your situation.

Start With Your Everyday Needs

There is no single Medicare choice that is right for every San Diego senior. Think about your doctors, medications, budget, travel, and how often you use healthcare services. Then compare the plans carefully.

SeniorTopia San Diego provides clear information about Medicare, wellness, senior living, activities, and other topics that matter to older adults. We explain important topics in simple language so San Diego seniors and their families can understand their options and make informed decisions.