Medigap vs Medicare Advantage: What Changes for Seeing Doctors and Using Telehealth

How do Medigap and Medicare Advantage differ for seeing doctors?

The biggest difference is who you can see and whether you need approval first. A Medicare Advantage plan may ask you to use doctors in its network and get approval before some care. Original Medicare with a Medigap policy usually doesn't. You can use telehealth on either path.

Medigap (Medicare Supplement Insurance) is extra insurance from a private company that helps pay your share of Original Medicare costs, like copayments, coinsurance and deductibles. Medicare Advantage is a different path: a Medicare-approved plan from a private company that you join instead of Original Medicare. You can't have both at once.

For the bigger picture, see how Medicare Advantage compares with Original Medicare and what's changing in Medicare Advantage for 2027.

Choosing your doctors

With Original Medicare, there's no network, and Medigap doesn't narrow your choices. Ask your doctors whether they take Medicare before you book.

A Medicare Advantage plan may ask you to use doctors and hospitals in its network and service area for care that isn't an emergency. Some plans cover care outside the network, but it may cost more. Networks can change from year to year, so check each doctor in the plan's directory before you choose.

Referrals and approvals

With Original Medicare, you usually don't need a referral to see a specialist. In most cases, you don't need approval first, called prior authorization, for Original Medicare to cover a service.

A Medicare Advantage plan may ask for a referral from your primary care doctor before you see a specialist. It may also need prior authorization for certain services and supplies. Your plan's Evidence of Coverage, the document that lists what the plan covers and what you pay, explains its rules.

Telehealth with Medigap or Medicare Advantage

Medicare's expanded telehealth rules, which let many people have video visits from home, run through December 31, 2027. If Original Medicare covers a video visit, Medigap can help pay your share.

Medicare Advantage plans may add telehealth benefits beyond Original Medicare. Check your plan's Evidence of Coverage to see which video visits it covers and what you pay.

A video visit can handle a renewal (a new prescription for a medicine you already take) or a new health question. Doctronic accepts Medicare, and you can see a licensed doctor by video.

Travel and care away from home

Original Medicare works anywhere in the U.S., so a trip or a second home doesn't change which doctors you can see. Outside the U.S., it generally doesn't pay, though some Medigap policies cover emergency care when you travel abroad.

A Medicare Advantage plan's network is tied to a service area. Care away from home that isn't an emergency may cost more or may not be covered. Plans generally don't cover care outside the U.S., though some offer an extra benefit for emergency and urgently needed care while you travel. If you travel often, check the plan's rules for care away from home.

Prescriptions

Medigap plans sold after 2005 don't include drug coverage. If you have Original Medicare and Medigap, you'd join a separate Medicare drug plan (Part D) for your prescriptions.

Most Medicare Advantage plans include Part D drug coverage, so you don't need a separate drug plan. Either way, check that each drug you take is on the plan's drug list. Also check whether it needs prior authorization or step therapy (trying a lower-cost drug first). Our guide to Medicare Part D in 2027 explains drug lists and tiers.

Changing your coverage later

You may not be able to buy a Medigap policy whenever you want one. Federal law gives you a 6-month Medigap Open Enrollment Period. It starts the first month you have Part B and you're 65 or older. During that time, an insurer can't turn you down because of health problems you already have.

After that, an insurer can deny you a policy, or charge more, based on your health. You have guaranteed issue rights only in certain situations. These rights mean an insurer must sell you a policy. The situations include:

• Your Medicare Advantage plan leaves your area or ends, or you move out of its service area.

• You joined Medicare Advantage when you turned 65 and leave it within the first year.

• You dropped a Medigap policy to join Medicare Advantage for the first time and leave within the first year.

Your state may give you more rights. Check with your State Insurance Department before you change coverage.

Where to get help

Doctronic isn't a licensed insurance agent or broker and doesn't recommend plans. For free, unbiased help:

• Medicare.gov: compare Medicare Advantage plans in the Medicare Plan Finder and look up Medigap policies sold where you live.

• 1-800-MEDICARE (1-800-633-4227): Medicare's own help line.

• Your State Health Insurance Assistance Program (SHIP): free, one-on-one counseling.

Frequently Asked Questions

Can I have Medigap and Medicare Advantage at the same time?

No. You can't use Medigap to pay Medicare Advantage copayments, deductibles or premiums. You also can't buy a Medigap policy while you're in a Medicare Advantage plan unless you're returning to Original Medicare.

Does Medigap cover dental, vision or hearing aids?

Generally, no. Medigap plans don't cover dental or vision care, glasses, hearing aids, nursing home care or private-duty nursing. Some Medicare Advantage plans offer dental, vision or hearing benefits, which vary by plan.

Does one Medigap policy cover my spouse too?

No. A Medigap policy covers only one person, so each spouse needs their own policy.

Are all Medigap plans with the same letter the same?

Yes, in most states. Medigap policies are standardized, so plans with the same letter offer the same basic benefits. Massachusetts, Minnesota and Wisconsin standardize them differently. In most cases, price is the main difference between companies selling the same letter.

Can I buy Medigap if I'm under 65?

It depends on your state. Federal law generally doesn't require insurers to sell Medigap to people under 65, though some states require insurers to offer at least one policy. Ask your State Insurance Department or SHIP what applies where you live.

The Bottom Line

Before you choose, list your doctors, your drugs and how often you travel. Then check whether each doctor takes Medicare or is in a plan's network, and whether each drug is on the plan's drug list. If you might want Medigap later, ask your State Insurance Department about your rights first.