Every fall, your mailbox fills up with slick brochures promising free dental, vision, and groceries if you switch to a Medicare Advantage plan.
What those mailers tend to leave out is the fine print on how you actually get care, and who profits when you sign up.
Original Medicare (Parts A and B) pays hospitals and doctors directly, and you can see any provider nationwide who accepts Medicare.
A Medigap supplement plugs the gaps — deductibles, coinsurance — in exchange for a predictable monthly premium.
Medicare Advantage, by contrast, is a private insurance plan that replaces the way you receive Original Medicare.
The government pays the insurer a set amount per member, and the insurer decides what's covered beyond the basics.
That per-member payment is the whole ballgame.
Insurers keep the difference between what the government pays them and what they spend on your care.
That's not automatically sinister — but it does mean the plan has a financial incentive to manage, review, and sometimes deny the services you request.
A 2023 federal review found that some Advantage plans denied prior-authorization requests that should have been approved.
If you've ever fought a denied claim, you know how exhausting that gets.
Advantage plans often carry $0 or low monthly premiums and throw in extras like dental, hearing aids, and gym memberships.
Medigap plans typically cost more each month but let you see a wider network of doctors and skip most prior-authorization fights.
Which one wins depends entirely on your health, your prescriptions, and whether your doctors are in the network.
The money angle matters most when you actually get sick.
With Original Medicare plus a solid Medigap plan, your out-of-pocket exposure is largely capped and predictable.
With Advantage, you face an annual out-of-pocket maximum that can run into the thousands, plus network restrictions.
A single serious diagnosis can turn a "free" plan into an expensive one.
People who are healthy and cost-conscious often love Advantage.
People managing chronic conditions often regret it.
Watch the sales tactics this enrollment season.
Brokers sometimes earn higher commissions on Advantage plans than on supplements, and that can color the advice you get.
Any agent who promises a plan will "cover everything" or "never deny care" is telling you something that isn't true.
Ask directly: What's my max out-of-pocket?
The honest answer is that neither option is universally better.
The question is which set of trade-offs you can live with — and whether the person selling it to you has an incentive to hide the downside.
Our take: treat these pitches like any other sales call.
The perks are real, but so is the fine print, and the plan that pays your broker the most isn't automatically the plan that protects you.
Final Thoughts
Run your own numbers before you sign anything.