Yushield – Financial Safety Starts Here

Medicare and Medicare-related health insurance are crucial for seniors. For example, in Texas, as of September 2024, approximately 2.54 million residents were enrolled in Medicare Advantage plans—representing 54% of the state’s 4.7 million Medicare beneficiaries. This figure reflects total enrollment rather than new sign-ups within a single year, as Medicare Advantage enrollment is continuous and includes annual renewals.

Regarding Medigap plans, by the end of 2023, nearly 950,000 Texans were enrolled in Medigap policies. These plans serve a significant portion of the 46% (2.16 million) of Medicare beneficiaries in Texas who remain on Original Medicare and often seek supplemental coverage.

While precise numbers for new purchases in 2025 are not yet available, the Centers for Medicare & Medicaid Services (CMS) projects continued growth in Medicare Advantage enrollment. Similarly, Medigap Plans G and N are expected to see steady growth due to their balanced combination of coverage and affordability.

This leads to an important question: Medicare Advantage vs. Medigap with Original Medicare — which option is better?

Here’s a clear comparison between Medicare Advantage (Part C) and Medigap (Medicare Supplement Insurance used with Original Medicare) to help you understand the key differences, along with their pros and cons:

🔍 Basic Definitions

Plan Type	Description
Original Medicare	Includes Part A (hospital) and Part B (medical), administered by the federal government.
Medicare Advantage (MA or Part C)	A private insurance plan that replaces Original Medicare, often includes Part D (drug), and may offer extra benefits.
Medigap (Supplement Insurance)	A private policy that works with Original Medicare to cover out-of-pocket costs like deductibles, coinsurance, and copayments.

✅ Medicare Advantage: Pros and Cons

✔️ Pros

• All-in-One Plan: Includes hospital, medical, and usually prescription drug coverage.
• Extra Benefits: May offer vision, hearing, dental, gym memberships, transportation, etc.
• Low or $0 Premiums: Many MA plans have low monthly premiums, though you must still pay Part B premium.
• Annual Out-of-Pocket Maximum: Caps your total spending, which Original Medicare does not.

❌ Cons

• Network Restrictions: HMO or PPO networks—must use in-network providers (especially in HMOs).
• Referrals Needed: Often need referrals for specialists.
• Geographic Limitations: May not cover you outside the service area (e.g., while traveling).
• Changing Plans Can Be Tricky: Medical underwriting may apply if you want to switch to Medigap later.

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✅ Medigap + Original Medicare: Pros and Cons

✔️ Pros

• Freedom to Choose Providers: See any doctor or hospital in the U.S. that accepts Medicare.
• Predictable Costs: Most out-of-pocket costs are covered (depending on the plan type, e.g., Plan G).
• No Referrals Needed: Direct access to specialists.
• Great for Travelers: Includes nationwide coverage and some plans offer foreign travel emergency coverage.

❌ Cons

• Higher Premiums: Medigap policies typically have monthly premiums, plus separate Part D (prescription) plan costs.
• No Extra Benefits: Doesn’t cover dental, vision, hearing, or fitness.
• Drug Plan Required Separately: You need to purchase a standalone Part D plan.
• Enrollment Limits: Outside your initial enrollment period, you may be denied coverage or charged more based on health.

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🧾 Cost Comparison (2025 Example Estimates)

Category	Medicare Advantage	Medigap + Original Medicare
Monthly Premium	$0–$50 (many at $0)	$100–$250 (varies by plan and age)
Part B Premium	Required (typically $174.70)	Required (same)
Out-of-pocket Max (2025)	$8,850 (in-network cap)	No cap, but Medigap covers most
Prescription Coverage	Included in most plans	Requires separate Part D plan
Dental/Vision/Hearing	Often included	Not covered

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💡 Summary Table

Feature	Medicare Advantage	Medigap + Original Medicare
Coverage Area	Local (network-based)	Nationwide
Provider Choice	Limited to plan network	Any Medicare provider
Specialist Access	Often needs referral	No referral needed
Extra Benefits	Often included	Rare
Premiums	Often lower	Usually higher
Cost Predictability	Less predictable	More predictable
Best For	Budget-conscious, prefers bundled services	Frequent travelers, prefers flexibility

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🧭 Which One Might Be Right for You?

Choose Medicare Advantage if:
✅ You want lower upfront monthly costs.
✅ You’re comfortable with network doctors.
✅ You like bundled dental, vision, and Rx.
✅ You don’t travel extensively.

Choose Medigap if:
✅ You want maximum provider flexibility.
✅ You travel often within the U.S. or abroad.
✅ You want predictable medical expenses.
✅ You can afford a higher monthly premium.