Medicare Part C vs Medigap: Costs, Coverage, and Real 2025 Scenarios

Estimated reading time: 7 minutes

Choosing between Medicare Part C and Medigap can feel overwhelming. Many people are confused by the differences between Medicare Part C vs Medigap, especially regarding coverage, costs, networks, and enrollment rules.

This guide provides a data-driven comparison to help you make an informed decision about which option best fits your healthcare needs and budget.

Also, it is important to note that even within healthcare the use of AI is becoming more common. Check out how AI is making health monitoring smarter: Wearables and Wellness Apps.

Key Takeaways

• Medicare Part C (Advantage) often includes extra benefits, while Medigap supplements Original Medicare.
• Medicare Part C plans may have lower premiums but higher out-of-pocket costs and network restrictions.
• Medigap plans offer greater flexibility in choosing providers but typically come with higher monthly premiums.

Medicare Part C vs Medigap Coverage: Side-by-Side Comparison

Feature	Medicare Advantage, Part C	Medigap, Supplement
Monthly premium	Often 0 to 60 dollars plus Part B	About 100 to 300+ dollars plus Part B
Out-of-pocket maximum	Yes, annual cap, 9,350 dollars in 2025 for in-network	No cap on most plans; K and L have limits, 7,220 and 3,610 dollars in 2025
Typical point-of-care costs	Copays and coinsurance per service	Usually minimal for covered services depending on plan letter
Network rules	HMO or PPO networks; out-of-network costs can be higher	No network, any provider that accepts Medicare
Referrals	Often needed in HMO plans	Not required
Part D drug coverage	Usually included	Not included; add a standalone Part D plan
Dental, vision, hearing	Common as extras with limits	Not included
Prior authorization	Common for many services	Rare; follows Original Medicare rules
Travel and nationwide access	Generally local networks; emergency coverage while traveling	Nationwide with any Medicare provider
Cost predictability	Lower premiums, variable costs with usage	Higher premiums, more predictable out-of-pocket
Best fit	Budget focused, comfortable staying in network, values extras	Wants broad access, frequent care, predictable bills

Notes: amounts are typical, vary by county and insurer. Use this table with the cost section and your ZIP code quotes.

Coverage Basics

Medicare Part C (Advantage):

• Functions as an alternative to Original Medicare through private insurance companies.
• Often bundles hospital, medical, and prescription drug coverage in one plan.
• May include extra benefits not covered by Original Medicare, for example dental, vision, and hearing.

Medigap (Supplement):

• Works alongside Original Medicare to fill coverage gaps.
• Helps pay Medicare deductibles, copayments, and coinsurance.
• Cannot be used with Medicare Advantage plans.
• Standardized plans labeled by letters A, B, C, D, F, G, K, L, M, N.

[Source: NCOA Medicare Basics]

Cost Structure

Premiums:

• Medicare Part C: Many plans have low or 0 dollar monthly premiums beyond your Part B premium.
• Medigap: Requires monthly premium payment in addition to your Part B premium.

Deductibles and Copays:

• Medicare Part C: Sets its own structure for copays and deductibles that vary by plan.
• Medigap: Benefits standardized by plan letter; many plans cover the Part A deductible and Part B coinsurance.

Out-of-pocket Maximums:

• Medicare Part C: All plans have an annual out-of-pocket maximum, 9,350 dollars cap for in-network services in 2025.
• Medigap: Most plans do not have out-of-pocket limits because they cover most costs. Plans K and L have annual limits, 7,220 and 3,610 dollars in 2025.

[Source: NCOA Medicare Costs]

Network & Provider Access

Medicare Part C:

• Typically uses restricted provider networks, HMO or PPO.
• May require referrals from primary care physicians to see specialists.
• Usually limited to in-network providers except for emergencies.

Medigap:

• No network restrictions beyond Medicare acceptance.
• Can see any doctor or specialist nationwide who accepts Medicare.
• No referrals needed to see specialists.

[Source: Medicare Advantage vs Medigap Networks]

Prescription Coverage

Medicare Part C:

• Most Advantage plans include Part D prescription drug coverage.
• Drug formularies and costs vary by plan.

Medigap:

• Does not include prescription drug coverage.
• Requires enrollment in a separate Part D plan for medication coverage.

[Source: Medigap and Prescription Coverage]

“Understanding the coverage differences is the crucial first step in choosing between Medicare Part C and Medigap.”

Medicare Advantage vs Medigap Cost Comparison

Annual Cost Comparison

When comparing costs between Medicare Advantage and Medigap, consider your total annual expenses:

Medicare Advantage, Part C:

• Monthly premium, often 0 dollars.
• Copays and coinsurance when you receive services.
• Deductibles for medical and possibly drug coverage.
• All costs capped by the out-of-pocket maximum, 9,350 dollars in 2025.

Medigap:

• Monthly Medigap premium, typically higher than Advantage.
• Part B premium.
• Part B deductible, with Plan G.
• Separate Part D premium and drug costs.
• Few unexpected costs for covered services depending on plan letter.

The right choice depends on your health needs, budget, and preferences for predictability versus potentially lower upfront costs. As you weigh these decisions, consider how AI is playing a role in financial planning. See Make Better Decisions with AI: Virtual Assistants for Life’s Big Choices.

[Source: Medicare Advantage vs Medigap Video]

Medigap Plan G Cost 2025

Plan G has become one of the most popular Medigap options because:

• Plans C and F are not available to people new to Medicare after January 1, 2020.
• Plan G covers all the same benefits as Plan F except the Part B deductible.
• It offers comprehensive coverage with predictable costs.

Plan G premiums in 2025 vary significantly based on:

• Your age.
• Your location, state and county.
• The insurance company you choose.
• Whether the plan uses attained-age, issue-age, or community-rated pricing.

Monthly premiums typically range from 100 to 300 dollars or more depending on these factors.

[Source: Medicare Medigap Guide]

Interactive Cost Calculator Concept

Consider these factors when calculating your potential annual costs:

For Medicare Advantage:

• Monthly premium.
• Expected doctor visits with copays.
• Potential hospital stays.
• Prescription drug needs.
• Estimated annual out-of-pocket spending.

For Medigap plus Part D:

• Medigap monthly premium.
• Part B deductible, with Plan G.
• Part D plan premium.
• Expected prescription drug costs.

For many people, Medigap has higher predictable monthly costs and fewer unexpected expenses at the point of service, while Advantage plans often have lower premiums and variable costs based on usage. To simplify your decision, explore how AI in Your Pocket can help with everyday choices.

[Source: NCOA Medicare Comparison]

“Cost is only one piece of the puzzle. Consider what you are willing to pay upfront versus the potential for high out-of-pocket costs later.”

Medicare Supplement vs Advantage: Buyer Personas

Healthy Seniors

Medicare Advantage:

• Advantage: Lower monthly premiums mean less upfront cost.
• Risk: Potential for higher costs if unexpected health issues arise.
• Protection: Annual out-of-pocket maximum caps financial exposure.

Medigap:

• Advantage: Predictable expenses with minimal surprises.
• Downside: Higher fixed monthly premiums regardless of usage.
• Benefit: Freedom to see any Medicare provider nationwide.

[Source: NCOA Medicare Plan]

Average Healthcare Users

Medicare Advantage:

• Cost-effective when primarily using in-network providers.
• Extra benefits like dental and vision may provide value.
• One-stop coverage simplifies administration.

Medigap:

• Predictable costs regardless of healthcare utilization.
• Broader provider access without network restrictions.
• Separate Part D plan allows customized drug coverage.

[Source: Medicare Plan Options]

Chronic Condition Patients

Medicare Advantage:

• Consider the plan’s out-of-pocket maximum as protection against high costs.
• Evaluate whether specialists are in network.
• Check if the plan covers your specific medications.
• Disease management programs may provide additional support.

Medigap:

• Provides broader access to specialists nationwide.
• Minimizes out-of-pocket costs for frequent medical services.
• Offers consistent coverage without prior authorization hurdles.
• Higher fixed costs balanced against predictability.

[Source: Medicare Advantage vs Medigap]

“Different lifestyles and medical needs require careful consideration when deciding between Medicare Advantage and Medigap.”

Medicare Enrollment Period 2025

2025 Medicare Enrollment Periods

Choose the right window for your case. Estimate total yearly cost, confirm provider access, and check drug coverage before you switch.

Initial Enrollment Period, IEP

• When: Seven months around your 65th birthday, includes the three months before, your birthday month, and the three months after. If disabled, IEP occurs around the 25th month of disability benefits.
• You can: Enroll in Part A and Part B, add a standalone Part D plan, or choose a Medicare Advantage plan that bundles A and B, usually Part D.

Medigap Open Enrollment

• When: The six months that start the first month you have Part B and are 65 or older.
• You can: Buy any Medigap plan sold in your state with no medical underwriting. After this window, acceptance can be restricted in many states.

Annual Election Period, AEP

• When: October 15 to December 7.
• You can: Join, switch, or drop Medicare Advantage and Part D plans. Changes take effect January 1.

Medicare Advantage Open Enrollment, MA OEP

• When: January 1 to March 31.
• You can: If you are already in a Medicare Advantage plan, switch to another MA plan once, or return to Original Medicare and add Part D. This window does not let people on Original Medicare newly join MA.

General Enrollment Period, GEP

• When: January 1 to March 31.
• You can: Enroll in Part A and/or Part B if you missed IEP. Coverage usually starts the month after enrollment. Late penalties may apply.

Special Enrollment Periods, SEPs

• Common triggers: You move, you lose employer or union coverage, your plan changes its contract, you qualify for Extra Help or Medicaid.
• Five Star SEP: Once per year you can switch to a five star Medicare Advantage or Part D plan from December 8 through November 30, subject to availability in your county.

Related reads: Medicare Part C vs Medigap and Medicare Advantage dental coverage.

Medicare Advantage FAQs

Conclusion

The best fit depends on how you use care and how much price predictability you want. Medicare Advantage can keep premiums low and add extras like dental or vision, although networks and prior authorization rules may limit flexibility. Medigap pairs with Original Medicare and Part D, it raises monthly cost and reduces surprise bills, while keeping nationwide access to any provider that accepts Medicare.

Run the numbers for your county. Compare yearly totals, confirm your doctors and drugs, and check star ratings.

If you value lower premiums and are comfortable staying in network, a Medicare Advantage plan can work. If you want broad access and stable out-of-pocket costs for frequent care, a Medigap plan with Part D is likely the safer choice.

Next steps, scan our guides on Medicare Part C vs Medigap and Medicare Advantage dental coverage, then check local plans with your ZIP code.