How to Compare Medicare Advantage vs. Medigap in Texas
If you’re approaching Medicare eligibility in Texas, one of the biggest decisions you’ll face is whether to enroll in a Medicare Advantage plan or pair Original Medicare with a Medigap (Medicare Supplement) plan. Each option offers different coverage, costs, and flexibility—and the right fit depends on your health needs, budget, and preferences. In this guide, we’ll walk you through the key differences to help you make an informed choice.
Understanding the Basics
Before diving into the comparison, let’s recap how Medicare works:
- Original Medicare includes Part A (hospital insurance) and Part B (medical insurance).
- You can choose to enhance this coverage with a Medigap plan and a Part D prescription drug plan.
- Alternatively, you can opt for a Medicare Advantage plan (Part C), which bundles your coverage into one policy.
What Is Medicare Advantage?
Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans cover everything Original Medicare does—and often more. In Texas, Medicare Advantage plans may include extras like vision, dental, hearing, fitness memberships, or transportation benefits.
Key Features:
- Usually includes Part D (prescription coverage)
- Often has lower monthly premiums than Medigap
- Works with networks (HMO or PPO)
- May require referrals to see specialists
What Is Medigap (Medicare Supplement Insurance)?
Medigap plans help pay for the out-of-pocket costs not covered by Original Medicare, like deductibles, copays, and coinsurance. These plans are standardized across Texas and labeled by letter (Plan G, Plan N, etc.). You’ll also need to enroll in a separate Part D plan
for prescriptions.
Key Features:
- Offers predictable costs and nationwide coverage
- No need for referrals or provider networks
- Higher monthly premiums, but lower cost-sharing
- Great for frequent travelers or those with chronic conditions
Cost Comparison: Premiums vs. Out-of-Pocket Costs
In Texas, Medicare Advantage plans often have low or $0 monthly premiums, but you’ll pay more in copays when you use services. These costs can add up, especially if you need regular care.
Medigap plans, on the other hand, have higher premiums, but reduce or eliminate out-of-pocket costs. If you prefer stability and fewer surprises, Medigap may be the better value long-term.
Doctor Access and Flexibility
- Medicare Advantage Texas plans may limit you to a local network of providers in places like Kerrville, San Antonio, or Austin. You’ll need to check whether your doctor or hospital is in-network.
- Medigap plans offer access to any doctor or facility nationwide that accepts Medicare. This is helpful if you travel or split your time between locations.
Enrollment Timing Matters
You have more flexibility to enroll or switch Medicare Advantage plans during Annual Enrollment (Oct 15 – Dec 7). But with Medigap, your best time to enroll is during your Medigap Open Enrollment Period (six months after you start Part B), when you can’t be denied for health reasons.
When to Choose Medicare Advantage
- You want lower monthly premiums
- You’re okay with doctor networks and referrals
- You want extra benefits like dental or fitness
- You live in an area with strong Advantage plan options
When to Choose Medigap
- You want freedom to choose any doctor
- You need consistent, predictable coverage
- You travel frequently
- You want to minimize out-of-pocket medical costs
Final Thoughts: There’s No One-Size-Fits-All
Choosing between Medicare Advantage and Medigap in Texas comes down to your lifestyle, health status, and financial goals. Some Texans prefer the simplicity and extras of Advantage plans, while others value the flexibility and stability of Medigap.
Still unsure which route is right for you? Contact Advanced Insurance Group for a free, personalized Medicare consultation. Our licensed agents in Kerrville serve clients across Texas, helping you compare plans and find the right fit for your needs.