# Medicare: Advantage vs. Medigap **URL:** \ **Category:** In My Humble Opinion\ **Created:** [November 13, 2025, 3:22pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830 "2025-11-13T15:22:50Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![Raza](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/raza/32/213_2.png) [@Raza](https://boards.straightdope.com/u/Raza)\ **Post date:** [November 14, 2025, 11:31pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/61 "2025-11-14T23:31:48Z")
Just to add one tiny point that might be important to some: with Medigap Plan G there is some out-of-country coverage; I think that might be one differentiator versus Plan N. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [November 15, 2025, 7:42pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/62 "2025-11-15T19:42:55Z")
One of our kids was living in Germany when I turned 65, so that was a big factor. Never needed it, but you never know. She’s moving back to Europe soon, so it may still come in handy. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [November 15, 2025, 8:23pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/63 "2025-11-15T20:23:28Z")
I am fortunate enough that I won’t have to worry about choosing for myself ( my former employer’s insurance will act as a Medigap plan but better) but I did have to help my mother find a less expensive plan a couple of years ago. She had Plan F, I think, and she was basically paying for benefits she didn’t need - Part B excess charges are prohibited in NY and she never leaves the US. So you really have to look at your specific situation. ---
**Author:** ![P-man](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/p-man/32/3606_2.png) [@P-man](https://boards.straightdope.com/u/P-man)\ **Post date:** [November 16, 2025, 2:18pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/64 "2025-11-16T14:18:33Z")
I haven’t reached the age to apply for Medicare, but I was recently at a retiree meeting where a representative there was a State Health Insurance Advisory Program representative. I can’t speak about the reps from other states, but the folks from DC seemed very knowledgeable and helpful. ---
**Author:** ![commasense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/commasense/32/3017_2.png) [@commasense](https://boards.straightdope.com/u/commasense)\ **Post date:** [November 16, 2025, 5:15pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/65 "2025-11-16T17:15:23Z")
So we’ve checked, and it looks like we can switch my wife to a Medigap plan for 2026 with little or no trouble. Now I want to see what would be involved in switching me. As I mentioned in the OP, I’ve been on an advantage plan for more than five years. It may not be so simple. ---
**Author:** ![Railer13](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/railer13/32/9742_2.png) [@Railer13](https://boards.straightdope.com/u/Railer13)\ **Post date:** [November 16, 2025, 5:27pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/66 "2025-11-16T17:27:08Z")
> [@commasense](#): > > Now I want to see what would be involved in switching me. As I mentioned in the OP, I’ve been on an advantage plan for more than five years. It may not be so simple. Correct. The Medigap provider does not have to accept you. And be prepared to answer a lot of questions regarding your health. > Medigap plan applications typically include a series of health questions that inform a carrier of your current and past medical history. The carrier will use this information to determine whether to accept you. For example, a serious health condition such as congestive heart failure will likely disqualify you from almost all Medigap plan carriers. [Switching From Medicare Advantage Plan to Medigap Plan](https://boomerbenefits.com/switching-from-medicare-advantage-plan/#:~:text=Key%20Points,at%20what%20this%20process%20entails). ---
**Author:** ![Baal\_Houtham](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/baal_houtham/32/13604_2.png) [@Baal\_Houtham](https://boards.straightdope.com/u/Baal_Houtham)\ **Post date:** [December 23, 2025, 5:48am UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/67 "2025-12-23T05:48:40Z")
Something I wonder about: If a hypochondriac has a Medicare supplement plan where referrals are not required to visit a specialist, and there are no co-pays, are there any ways to limit their behavior. Can the person just call up, and schedule an appointment any time they’re feeling off? Presumably any specialist office will eventually ping that the symptoms are imaginary and stop accepting appointments. But there are dozens or hundreds of specialists in a big city. What are the likely results? ---
**Author:** ![OttoDaFe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ottodafe/32/356_2.png) [@OttoDaFe](https://boards.straightdope.com/u/OttoDaFe)\ **Post date:** [December 23, 2025, 8:38am UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/68 "2025-12-23T08:38:18Z")
The supplement plan provider will rarely (I’m sore tempted to say never) make any determination whether an office visit or procedure is warranted: that’s done by Medicare, and the supplement plan only covers the part that Medicare doesn’t pay. ---
**Author:** ![Baal\_Houtham](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/baal_houtham/32/13604_2.png) [@Baal\_Houtham](https://boards.straightdope.com/u/Baal_Houtham)\ **Post date:** [December 23, 2025, 11:02am UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/69 "2025-12-23T11:02:00Z")
Thank you, Mr. DaFe. So, my new understanding (which you or anyone else can correct) is that the specialist’s office would fill out a Medicare reimbursement form, which lists the patient’s symptoms. That symptom list defines what level of reimbursement the specialist can expect from Medicare, which effectively limits the number of visits the patient can have with that office for that particular health problem. As well as the type of treatment. Those limits can be adjusted if the medical offices convinces Medicare that the patient needs special treatment. Does the specialist also have to submit reimbursement forms to the Medicare Supplement company? And does the Supplement company have its own set of reimbursement guidelines, or does it just blankly follow guidelines set by Medicare? Sigh. Life is not simple. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 23, 2025, 12:54pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/70 "2025-12-23T12:54:08Z")
> [@Exapno\_Mapcase](#): > > If you can, book an appointment with a local advisory group before making any decisions. How does one find a good local advisory group? ---
**Author:** ![BippityBoppityBoo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bippityboppityboo/32/5745_2.png) [@BippityBoppityBoo](https://boards.straightdope.com/u/BippityBoppityBoo)\ **Post date:** [December 23, 2025, 1:29pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/71 "2025-12-23T13:29:04Z")
> [@puzzlegal](#): > > How does one find a good local advisory group Plug your location into this State Health Insurance Program locator and contact them. free, trained, informed, unbiased advisors with no interest in selling you something for their gain. > **[Get Medicare Help from Your Local SHIP Program | SHIP TA Center](https://www.shiphelp.org/)** > > Get trusted, local Medicare help from SHIP. We connect you with counselors to provide guidance on Medicare enrollment, coverage, and costs. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 23, 2025, 1:45pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/72 "2025-12-23T13:45:37Z")
Which directs me to a website run by my state, which provides services. Thanks! ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [December 23, 2025, 3:00pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/73 "2025-12-23T15:00:05Z")
I don’t know that there are enough hypochondriacs (who aren’t exactly reporting imaginary symptoms) \* who would go straight to a specialist for insurance companies ( including Medicare and supplements ) to have policies specifically aimed at preventing someone from going straight to a neurologist for their headaches , for example. Sure, there are some, but a lot of them will go to a primary provider first , for any number of reasons ranging from long waits at specialists, to the fact that some specialists won’t see a patient without information from a primary provider. \* Factitious disorder (previously known as Munchausen’s syndrome) involves making up or even causing symptoms - it’s very rare. ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [December 23, 2025, 3:11pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/74 "2025-12-23T15:11:58Z")
I’d also question whether the issue with “hypochondriacs” is any different under Medicare than it is under any other insurance system in the USA. Wackos wasting care is a drop in the bucket compared to deliberate over-coding and over-charging and other forms of fraud. ---
**Author:** ![Railer13](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/railer13/32/9742_2.png) [@Railer13](https://boards.straightdope.com/u/Railer13)\ **Post date:** [December 23, 2025, 3:18pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/75 "2025-12-23T15:18:35Z")
> [@LSLGuy](#): > > I’d also question whether the issue with “hypochondriacs” is any different under Medicare than it is under any other insurance system in the USA. Just what I was going to say. I would also speculate that the number of senior (65+) hypochondriacs is far less than younger ages. Most folks my age that I know don’t really want to go to the doctor more than necessary. ---
**Author:** ![Baal\_Houtham](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/baal_houtham/32/13604_2.png) [@Baal\_Houtham](https://boards.straightdope.com/u/Baal_Houtham)\ **Post date:** [December 23, 2025, 4:09pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/76 "2025-12-23T16:09:21Z")
Hi @LSLGuy @doreen . The hypochondria hypothetical was a way to ask how Medicare w supplemental regulated care. The mechanism seemed less obvious than with Advantage plans, which have the PCP as a gatekeeper, more co-pays, and the low-fee specialist all under one umbrella. I wasn’t really positing hypochondriacs as a big Medicare Budget pie slice. And @BippityBoppityBoo could you share some details of your “clients who died while waiting for Advantage plans to authorize treatments. Died. Lots more than one.” I’d be interested. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [December 23, 2025, 4:25pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/77 "2025-12-23T16:25:56Z")
> [@Baal\_Houtham](#): > > Hi @LSLGuy @doreen . The hypochondria hypothetical was a way to ask how Medicare w supplemental regulated care. The mechanism seemed less obvious than with Advantage plans, which have the PCP as a gatekeeper, more co-pays, and the low-fee specialist all under one umbrella. I wasn’t really positing hypochondriacs as a big Medicare Budget pie slice. I get that but there are plenty of other non-Medicare insurance plans that don’t require actual PCP referrals to see a specialist. To the extent that it’s an issue, it’s not only an issue for Medicare. And there’s a real question about whether enough people would actually go straight to a specialist for a new problem without seeing a PCP, even if no referral is needed - if hardly anyone does it , it’s not necessarily worth bothering to prevent it. And if it’s usually appropriate , it’s possibly not worth preventing it. For example, many years ago, when I had insurance that required referrals, it did not require a referral for OB/GYNs. Most likely because it would cost the insurance company more to pay for both a PCP visit and the specialist visit every time a woman needed a pap smear or an exam or found out she was pregnant. ---
**Author:** ![Ancient\_Nerd](https://avatars.discourse-cdn.com/v4/letter/a/ed655f/32.png) [@Ancient\_Nerd](https://boards.straightdope.com/u/Ancient_Nerd)\ **Post date:** [December 23, 2025, 8:46pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/78 "2025-12-23T20:46:27Z")
There is a way that signing up for part A can cost you. Having part A makes you ineligible to contribute to an HSA. Part A is automatic when you start social security. In fact they make it retroactive. If you have been putting the maximum into your HSA when you start SS, you need to pull it out and pay taxes on it. I waited a little longer than I should have to start SS. They made it retroactive and sent me a lump sum. That made for a really long retroactive part A period. My poor HSA was devastated. ---
**Author:** ![SunUp](https://avatars.discourse-cdn.com/v4/letter/s/ea5d25/32.png) [@SunUp](https://boards.straightdope.com/u/SunUp)\ **Post date:** [December 23, 2025, 9:52pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/79 "2025-12-23T21:52:47Z")
> [@Ancient\_Nerd](#): > > I waited a little longer than I should have to start SS. They made it retroactive and sent me a lump sum. Do you mean you waited until you were past full retirement age, or past age 70 if you were waiting for the maximum delayed retirement credits? AFAIK the Social Security Administration can’t force someone to make a claim for benefits retroactive, but I might well be wrong on that. ---
**Author:** ![Railer13](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/railer13/32/9742_2.png) [@Railer13](https://boards.straightdope.com/u/Railer13)\ **Post date:** [December 23, 2025, 10:02pm UTC](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830/80 "2025-12-23T22:02:16Z")
> [@Ancient\_Nerd](#): > > If you have been putting the maximum into your HSA when you start SS, you need to pull it out and pay taxes on it. I don’t think that’s right. You can no longer contribute to it, but there’s nothing that says you have to start using the HSA funds when you start SS. Plus, if you use HSA funds for qualified medical expenses, it doesn’t count toward your income, so it’s tax-free. [Previous page](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830.md?page=3) [Next page](https://boards.straightdope.com/t/medicare-advantage-vs-medigap/1024830.md?page=5)