Medicare Advantage vs. Medigap: How to Choose (Florida Rules Included)

McIntosh Insurance Group doesn’t sell Medicare plans. This article is general information. For free, unbiased help with your Medicare choices in Florida, contact SHINE at 1-800-963-5337 or floridashine.org.

When you join Medicare, one of the biggest choices is how to fill the gaps in Original Medicare: with a Medicare Advantage plan, or with Original Medicare plus a Medicare Supplement (Medigap) policy and a Part D drug plan. They work very differently, and in Florida, switching later isn’t always possible.

How each option works

Original Medicare plus Medigap

Original Medicare (Parts A and B) works with any doctor or hospital in the country that accepts Medicare, usually without referrals. On its own it has no yearly limit on what you pay. A Medigap policy pays some or all of the costs Original Medicare leaves behind, such as deductibles and coinsurance. You add a separate Part D plan for prescriptions.

Medicare Advantage (Part C)

A Medicare Advantage plan is a private plan that bundles Parts A and B, and usually Part D, into one. Most use a provider network and may require prior authorization for some services. Many include extras like dental, vision and hearing benefits. Every Medicare Advantage plan has a yearly out-of-pocket limit for covered services, which varies by plan.

Side by side

	Original Medicare + Medigap	Medicare Advantage
Doctors and hospitals	Any provider nationwide that accepts Medicare	Usually a network; out-of-network care may cost more or not be covered
Referrals and prior authorization	Generally not required	Often required for specialists or some services
Monthly premiums	Part B, plus Medigap and Part D premiums	Part B, plus the plan premium, which is often low or $0
Costs when you get care	Low and predictable, depending on the Medigap plan	Copays and coinsurance up to the plan’s yearly limit
Drug coverage	Separate Part D plan	Usually included
Extras	Generally not included	Often dental, vision, hearing or fitness benefits
Travel	Coverage anywhere in the U.S. that accepts Medicare	Usually limited to the plan’s service area except emergencies

Understanding Medigap plans

Medigap plans are standardized and named by letter. In most states, every Plan G has the same benefits no matter which company sells it, so price and service are the only differences. Massachusetts, Minnesota and Wisconsin use their own standardized plans.

Plan G covers everything Original Medicare leaves you to pay except the Part B deductible. It’s the most complete plan available to people new to Medicare since 2020.
High-deductible Plan G has a lower premium but a deductible of $2,950 in 2026 and $3,050 in 2027 before it pays.
Plan N has lower premiums in exchange for copays of up to $20 for some office visits and up to $50 for emergency room visits that don’t lead to an admission.
Plans C and F are available only to people who were eligible for Medicare before January 1, 2020.

Why timing matters so much

Your Medigap Open Enrollment Period is a one-time, six-month window that starts the first month you have Part B and are 65 or older. During it, an insurer must sell you any Medigap policy it offers, at its standard price, regardless of your health. After it ends, insurers can generally ask health questions and turn you down unless you have a guaranteed-issue right, which usually comes from losing other coverage (apply within 63 days).

That’s why the first choice matters: it’s easy to move from Medigap to Medicare Advantage during Medicare Open Enrollment, but moving from Medicare Advantage back to Medigap later may mean passing medical underwriting.

Trial rights

If you dropped a Medigap policy to join Medicare Advantage for the first time, you have 12 months to get that same policy back, if it’s still sold.
If you joined Medicare Advantage when you first became eligible at 65, you can switch to any Medigap policy within the first year.

Also note that a Medigap policy can’t pay your Medicare Advantage costs. You don’t need, and shouldn’t keep, both.

Florida rules to know

No birthday rule. Some states let you switch Medigap plans each year around your birthday without health questions. Florida doesn’t.
Under 65 with Medicare? Floridians on Medicare because of a disability or end-stage renal disease get a six-month Medigap open enrollment once they have Part B, and another when they turn 65.
Losing employer coverage. Florida gives a two-month Medigap open enrollment when your employer group health plan ends, if you have Part B.
Guaranteed renewable. A Florida Medigap policy can be canceled only for not paying the premium or for a material misrepresentation on the application.

Questions to ask yourself

Do you want to keep specific doctors or hospitals, and are they in the plan’s network?
Do you travel or split the year between states?
Would you rather pay more each month for predictable costs, or less each month with costs when you use care?
Do you need dental, vision or hearing coverage, and is it worth trading network flexibility for it?
Are you inside your Medigap Open Enrollment Period, when your health can’t be used against you?

Free help in Florida

SHINE, a program of the Florida Department of Elder Affairs, offers free, unbiased and confidential Medicare counseling. Call 1-800-96-ELDER (1-800-963-5337) or visit floridashine.org. See also our Medicare enrollment timeline.

Sources

CMS, Medicare & You 2027: https://www.medicare.gov/publications/10050-medicare-and-you.pdf
CMS, Choosing a Medigap policy: https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf
Medicare.gov, Medigap: ready to buy: https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy
Medicare.gov, Medicare costs: https://www.medicare.gov/basics/costs/medicare-costs
CMS, Medigap high-deductible plan F, G and J deductible announcements: https://www.cms.gov/medicare/health-drug-plans/medigap/f-g-j-deductible-announcements
Florida Statutes, section 627.6741: https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.6741.html
Florida Office of Insurance Regulation, Medigap FAQs: https://floir.gov/docs-sf/default-source/floir-documents/medigap-faqs.pdf
Florida SHINE: https://www.floridashine.org/

Medicare Advantage vs. Medicare Supplement: How to Choose