Plan G vs Medicare Advantage: A Side-by-Side Look

Two Different Approaches to Coverage

When it comes to Medicare coverage, retirees generally choose between two main paths. The first is Original Medicare (Parts A and B) combined with a Medigap supplemental policy and a separate Part D prescription drug plan. The second is a Medicare Advantage plan (Part C), which bundles hospital, medical, and often drug coverage into a single plan.

Each approach manages risk differently. Understanding these differences is essential for making an informed enrollment decision.

Original Medicare + Plan G

Plan G is one of the most popular Medigap policies available. It generally covers many of the beneficiary cost-sharing gaps for Medicare-covered Part A and Part B services, including hospital coinsurance, skilled nursing facility coinsurance, Part A hospice coinsurance, and the Part A deductible.

Plan G does not cover the annual Part B deductible. After meeting this deductible, Plan G generally pays the remaining Medicare cost-sharing — making out-of-pocket costs more predictable.

With Original Medicare + Plan G, beneficiaries can typically see any doctor or hospital that accepts Medicare patients nationwide, without needing referrals or prior authorization for covered services. A separate Part D plan is normally needed for outpatient prescription drug coverage.

Medicare Advantage

Medicare Advantage plans are offered by private insurance companies approved by Medicare. Many plans have $0 premiums (beyond the required Part B premium) and may include additional benefits such as dental, vision, hearing, and fitness programs.

However, Medicare Advantage plans typically involve cost-sharing when care is used: copayments for doctor visits, coinsurance for procedures, and deductibles for hospital stays. Importantly, Medicare Advantage plans do have an annual out-of-pocket maximum for covered Part A and Part B services — a protection that Original Medicare alone does not provide.

Provider access depends on the plan type. HMO plans generally require in-network care except for emergencies. PPO plans may allow out-of-network care at higher cost. Some services may require prior authorization or a referral.

"Best choice equals personal fit. Consider your doctors, prescriptions, travel habits, budget, and risk tolerance."

Key Considerations

• Provider flexibility: Original Medicare generally offers broader provider access; Medicare Advantage may restrict choices to a network.
• Cost predictability: Plan G offers more predictable cost-sharing; Medicare Advantage costs depend on how much care you use.
• Maximum exposure: Medicare Advantage has an annual out-of-pocket cap; Original Medicare alone does not (though Medigap limits exposure differently).
• Timing: Medigap access is time-sensitive. The six-month Medigap Open Enrollment Period begins when you first enroll in Medicare Part B at age 65 or older.