You turn 65, and suddenly your mailbox fills with Medicare mailers. Your phone rings with plan comparisons. A neighbor swears by her Medicare Advantage plan. Your brother-in-law insists a Supplement is the only smart choice. And you’re left wondering: which one is actually right for me?

It’s one of the most consequential financial decisions you’ll make in retirement — and one of the most misunderstood. The wrong choice can cost you thousands of dollars per year, limit access to the doctors you trust, or leave you exposed to unexpected medical bills at exactly the moment you can least afford them.

At Legacy Wealth Services, we help clients across 26 states navigate this decision every day. This guide gives you the straight facts — no sales pitch, no jargon — so you can make the choice that fits your life.

Ready to talk through your specific situation? Explore your Medicare options →

First, Understand the Foundation: Original Medicare

Before comparing plans, it helps to understand what you’re building on. Original Medicare consists of:

Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, and some home health services. Most people pay $0 in premiums for Part A if they’ve worked 40+ quarters. The inpatient hospital deductible is $1,676 per benefit period in 2025.
Part B (Medical Insurance): Covers doctor visits, outpatient services, and preventive care. The standard monthly premium is $202.90 in 2026, with an annual deductible of $257.

Here’s the critical gap: Original Medicare covers roughly 80% of approved medical costs. The remaining 20%? That’s your responsibility — with no annual out-of-pocket maximum. A serious illness or hospital stay could expose you to tens of thousands of dollars in costs.

That’s the problem both Medicare Advantage and Medicare Supplement plans are designed to solve. They just solve it very differently.

Medicare Advantage vs. Medicare Supplement: The Core Difference

Feature	Medicare Advantage (Part C)	Medicare Supplement (Medigap)
How it works	Replaces Original Medicare; plan manages your care	Works alongside Original Medicare; fills the “gaps”
Monthly premium	Often $0–$50/mo (avg. ~$13/mo in 2025)	Typically $135–$270/mo at age 65
Out-of-pocket maximum	Required by law; avg. ~$5,320/yr in-network (2025)	Varies by plan; Plan G covers nearly all gaps
Network restrictions	Usually HMO or PPO — network required	Any doctor/hospital that accepts Medicare
Prescription drugs	Often included (MAPD plans)	Must purchase separate Part D plan
Extra benefits	May include dental, vision, hearing, fitness	No extra benefits; pure coverage
Prior authorization	Common for procedures and specialists	Generally not required
Best for	Healthy, budget-conscious, value extras	Those wanting predictability and maximum freedom

Medicare Advantage Plans: The Pros and the Honest Cons

What Medicare Advantage Does Well

Low or no monthly premiums. In 2025, the enrollment-weighted average MA premium is just $13 per month — and many plans are available at $0 beyond your Part B premium. For retirees on a fixed income, that’s a meaningful difference.

Extra benefits Original Medicare doesn’t cover. Many Advantage plans bundle dental, vision, hearing, and fitness memberships (like SilverSneakers) — benefits that can be worth hundreds of dollars per year.

Prescription drug coverage included. Most Medicare Advantage plans are MAPD plans (Medicare Advantage + Prescription Drug), combining your medical and drug coverage in one plan.

Out-of-pocket cap. Unlike Original Medicare, Advantage plans are required to cap your annual out-of-pocket costs. In 2025, the average in-network cap is approximately $5,320, though plans can set limits up to $9,350 for in-network services.

Where Medicare Advantage Has Limitations

Network restrictions. Most MA plans are HMOs or PPOs. If your preferred specialist is out of network — or if you travel frequently and need care away from home — you may face significantly higher costs or no coverage at all.

Prior authorization requirements. Many Advantage plans require pre-approval for specialist visits, procedures, and certain medications. This can create delays in care and added administrative burden.

Plans change annually. Benefits, premiums, formularies, and networks can shift every year during the Annual Enrollment Period. A plan that works well for you in 2025 may look very different in 2026.

Harder to switch later. If you enroll in Medicare Advantage and later want to move to a Supplement plan, you may face medical underwriting in most states — meaning you could be denied or charged more based on your health history.

Medicare Supplement (Medigap) Plans: The Pros and the Honest Cons

What Medigap Does Well

Predictable costs and true freedom. With a Medigap plan — particularly Plan G (the most popular for new enrollees since 2020) — your costs are almost entirely predictable. You pay your monthly premium plus the Part B deductible ($257 in 2025), and Plan G covers the rest of your Medicare-approved expenses.

See any doctor, anywhere. Medigap works with any provider that accepts Medicare — nationwide. No networks, no referrals required. This is invaluable for frequent travelers, snowbirds, or anyone with established specialist relationships they’re not willing to give up.

No prior authorization. If Medicare approves it, your Supplement pays. Period.

Stability. Unlike Advantage plans, Medigap benefits don’t change year to year. Your Plan G in 2025 covers the same things as Plan G in 2030.

Where Medigap Has Limitations

Higher monthly premiums. Plan G typically runs $220–$270 per month at age 65, depending on your state and carrier. Plan N (which has some cost-sharing) averages $135–$170 per month. That’s a meaningful monthly commitment.

No prescription drug coverage. You’ll need to purchase a separate Part D plan for prescriptions, adding another monthly premium and layer of management.

No extra benefits. Medigap is pure coverage — no dental, vision, or gym membership. You’ll need to budget for these separately.

Who Is Each Plan Best For?

Medicare Advantage May Be the Right Fit If You:

Are in good health and don’t anticipate frequent specialist or hospital visits
Are budget-focused and want to minimize monthly premium costs
Value bundled benefits like dental, vision, and fitness
Have a strong local network of preferred providers in your plan’s coverage area
Are comfortable managing annual plan changes and potential prior authorization processes

Medicare Supplement May Be the Right Fit If You:

Have chronic conditions or see multiple specialists regularly
Travel frequently, split time between states, or winter in a different region
Value financial predictability and want to know exactly what you’ll owe
Have existing doctor relationships you’re unwilling to give up
Want to lock in coverage while you’re healthy and insurable

The Real Cost Comparison: Running the Numbers

Let’s look at a simplified annual cost comparison for a 65-year-old enrolling in 2025:

Scenario: Moderate healthcare use (a few specialist visits, one minor procedure)

Cost Item	Medicare Advantage (PPO, $0 premium)	Medigap Plan G + Part D
Monthly premium	$0	~$250 (Plan G) + ~$35 (Part D) = $285
Annual premiums	$0	$3,420
Part B deductible	$257	$257 (not covered by Plan G)
Copays/coinsurance	~$500–$1,500 est.	$0 after deductible
Estimated annual cost	$757–$1,757	$3,677

Scenario: High healthcare use (hospitalization, multiple specialists)

Cost Item	Medicare Advantage (PPO, $0 premium)	Medigap Plan G + Part D
Annual premiums	$0	$3,420
Out-of-pocket costs	Up to $5,320 (avg. OOP max)	~$257 (Part B deductible only)
Estimated annual cost	Up to $5,320	~$3,677

The math shifts dramatically with higher utilization. For healthy individuals, Advantage can deliver real savings. For those with significant healthcare needs, a Supplement’s predictability often wins — both financially and emotionally.

A Decision Framework: 5 Questions to Ask Before You Choose

Before enrolling in any Medicare plan, work through these five questions:

How is my health today — and what’s my family history? If chronic conditions or significant healthcare use are likely, predictability matters more than premium savings.
Do I travel frequently or spend time in multiple states? If yes, Medigap’s nationwide any-provider access is a significant advantage.
How important is keeping my current doctors? If you have established specialist relationships, confirm they’re in-network before choosing an Advantage plan.
What’s my monthly budget tolerance? Can you comfortably absorb $250–$285/month in Medigap premiums, or does a $0 premium plan better fit your cash flow?
Am I enrolling at 65 — or switching later? At 65, you have guaranteed issue rights for Medigap in most states. Waiting or switching later may mean medical underwriting.

One more question worth asking: Have you optimized when you’ll take Social Security? The timing of your Social Security claim can mean the difference of tens of thousands of dollars — and it directly affects how much Medicare premium you’ll pay. Learn about our RSSA Social Security Analysis →

The Bottom Line

There is no universally “best” Medicare plan — only the plan that’s best for your health, finances, lifestyle, and priorities. Medicare Advantage wins on premium cost and bundled benefits. Medicare Supplement wins on freedom, predictability, and peace of mind.

What matters most is making this decision with full information, not just the loudest mailer in your mailbox.

At Legacy Wealth Services, Rod works with clients across 26 states to compare plans side by side — across a wide portfolio of carriers — so you see the real numbers for your zip code, your health history, and your retirement goals. There’s no pressure, no single carrier agenda, and no confusing fine print left unexplained.

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Legacy Wealth Services serves clients across 26 states. Rod Cummings is a licensed insurance professional helping families make confident, informed decisions about Medicare, retirement income, and financial protection. This article is for informational purposes and does not constitute legal, tax, or personalized financial advice. Medicare plan availability and costs vary by location and are subject to annual change.

Schedule your free Medicare review at https://calendly.com/rod-legacywealthservices/30min