Every fall, 68 million Americans on Medicare get buried in glossy mailers promising free dental, free groceries, free gym memberships.
Almost none of them explain what you give up.
Private insurers run your coverage, and the government pays them a fixed fee per member.
In 2024, that fee averaged roughly $15,000 per person, according to KFF.
Insurers keep whatever they don't spend on your care — which is the entire business model, not a side note.
The $50 grocery card and the vision stipend are bait.
The real product is a narrow network, prior authorizations, and a cap on what the plan will pay in a given year.
The government pays your bills directly, and you can see any provider in the country who accepts Medicare.
But there's no out-of-pocket ceiling, which is why most people bolt on a Medigap supplement.
Here's the tradeoff nobody puts on a postcard.
A Medigap Plan G for a 65-year-old runs about $120 to $180 a month in most states, on top of the standard Part B premium of $185 in 2025.
Advantage plans often advertise $0 premiums.
A study published in JAMA Health Forum found that Medicare Advantage enrollees were more likely to land in the hospital for conditions that better outpatient care could have prevented.
KFF polling found that nearly a third of Advantage enrollees who needed prior approval said it delayed their care.
A denied MRI doesn't feel like a benefit.
There's also a quieter risk: the extras are not guaranteed.
That grocery allowance can shrink to a pharmacy coupon by next January, and you may not find out until you're standing at the register.
Medigap has its own trap, and it's a nasty one.
Outside your initial six-month enrollment window, insurers in most states can reject you or charge more because of your health history.
Miss that window and you may be locked out of the best coverage for life.
In New York and Connecticut, rules are friendlier.
So the honest answer is that neither option wins for everyone.
If you have a chronic condition and can afford the premium, Medigap buys you the thing money can't easily replace — access to any specialist without a fight.
If you're healthy, live on a tight budget, and your doctors are already in-network, Advantage can work fine for years.
The part that should make you angry is the marketing.
Brokers get paid more for enrolling you in Advantage than for a supplement.
That's not a conspiracy; it's a commission schedule.
It just means the person "helping" you has a financial reason to lean one way.
Before you decide, check three things with neutral sources, not the mailer.
Ask whether your doctors and hospital are in the specific plan's network for next year.
Ask what the plan's out-of-pocket maximum is and whether your prescriptions are on the formulary.
And ask what happens if you want to switch later — because for many people, that door closes quietly.
The government isn't going to send you a letter explaining the catch.
That leaves you, a phone, and about an hour of actual homework. **The bottom line:** These are two genuinely different products with genuinely different failure modes, and the sales pitch is built to blur that line.
If you can afford Medigap, buy it while you still have the right to.
Final Thoughts
If you go with Advantage, go in with your eyes open and re-check the plan every single year.