My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?

Question

Tammie Rutledge · Accepted Answer

Medicare Advantage Plans are not FREE.  They may have a $0 premium.  However, you must continue to pay your Medicare part B premium to qualify for a Medicare Advantage Plan.

Gary Church · Answer

Medicare Medigap offers true freedom in healthcare choice, allowing you to see any doctor nationwide who accepts Medicare—no referrals, no network restrictions. In contrast, while Medicare Advantage plans may offer zero premiums, they often require referrals and can change annually. Your doctor may be in-network one year but not the next. If you experience a life-changing event and require hospitalization, unexpected medical bills could reach thousands of dollars. With a Medigap plan, your only out-of-pocket cost beyond the monthly premium is the Part B deductible, which is set by Medicare each year—$257 for 2025."

Answered by Gary Church on May 19, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Andrew Zurbuch, MBA · Answer

The Medicare Advantage have out of pocket costs to the Medicare Beneficiary. Copays &/or a coinsurance. Could be 20% out of pocket. 

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Paul Potter · Answer

Everyone is different.  We all have different genes, needs, preferences etc.  Your neighbor does not tell you what food you like, what investments to make and more.  Tell them thank you for caring and your advice.

It is true that in Florida around 60% of people turning 65 get Medicare Advantage Plans, but that also means that around 30% get Medicare Advantage.

If you are uncertain about comparing options, I can provide a no obligation comparison specific to your needs and preferences.

Joseph Meyers · Answer

I help folks in Michigan and after your initial enrollment into medicare here, you will have to health qualify for medigap(supplemental) plans. With our health you never know what is around the corner. If serious health issues wiping out your savings is a concern...and it should be. Medigap plans are the safest option.

Answered by Joseph Meyers on April 7, 2025

Broker Licensed in MI & TN

Answered by Joseph Meyers Medicare Insurance Agent

Colleen Williams · Answer

Everyone's circumstances are different, along with their preferences and affordability as well. What works for one individual may not apply to what his or her neighbor has. This is why it's important to sit down with a licensed agent to review the plan/s that will work specifically for you.

Answered by Colleen Williams on May 20, 2025

Agent Licensed in PA, FL & NJ

Answered by Colleen Williams Medicare Insurance Agent

Steven Bleicher · Answer

If you wish to turn the tables on him but remain his friend, I would tactfully say that “how can a Medigap be so popular for so long without it being a terrific choice?!” Apparently, he never got the message: “Nothing is free in this world!” Having a free of premium plan due to the Feds subsidizing it means that there is a “give and take”! Yes, you are taking on a free plan. But in exchange, you are acquiring a lifetime deductible in the area of $3,000.00 per year if you were ever hospitalized. Plus, with our global inflation now in effect, that amount is prone to an increase every single new calendar year! So, you are in the right!

Answered by Steven Bleicher on June 4, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Timothy Brown · Answer

There is no such thing as “free” Medicare Advantage. There are plans that have a $0 monthly premium but unless a person has full Medicaid benefits, they will be subject to copays and/or coinsurance for services beyond a primary care visit.

Answered by Timothy Brown on June 20, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent

Dana Dane · Answer

Ask them if they can seek treatment (other than an emergency) with any doctor/hospital/facility nationwide that accepts Medicare. Ask them what their annual maximum out-of-pocket is in-network and out-of-network? Ask them if their plan changes from year to year.

Answered by Dana Dane on April 14, 2025

Agent Licensed in OR, AZ, CA & 6 other states

Answered by Dana Dane Medicare Insurance Agent

Satoshi Aoki · Answer

2 types of coverage have advantages and disadvantages:

Medigap:
Higher monthly premiums, but allows you to use any doctor or hospital nationwide that accepts Medicare. Out-of-pocket costs are generally low and predictable. Prescription drug coverage and extra benefits (such as dental or vision) are not included and require separate plans.

Medicare Advantage:
Lower or sometimes zero monthly premiums, and plans include extra benefits such as dental, vision, hearing, and prescription drug coverage(but not every plan). However, you are limited to network providers in your local area, and sometimes doctors or facilities decide to discontinue, and the plan details can change each year.

James Stang · Answer

Medigap plans offer the ability to see any doctor that accepts Medicare without any networks. You also have no co-pays when you access services. Medigap plans might not be right for everyone but they do have advantages.

Answered by James Stang on June 3, 2025

Agent Licensed in OH

Answered by James Stang Medicare Insurance Agent

John Lopez · Answer

The major differences between Medigap and Medicare Advantage have to with cost, coverage, and change. With a Medigap Plan, there is a larger monthly premium and most subscribers will be responsible for the annual part B deductible. Coverage with a Medigap plan is restricted to medical expenses only. Medicare Advantage plans can include other services, like dental, vision and hearing coverage, as well as value added benefits, such as gym memberships. With a Medigap policy, there is very little change (other than any policy rate increase). Your primary coverage is Medicare. There is a potential for more change with a Medicare Advantage plan, especially with approved providers in the HMO or PPO network.

Answered by John Lopez on May 19, 2025

Broker Licensed in DE, MD, NC, NJ, NY & PA

Answered by John Lopez Medicare Insurance Agent

Denise Berg · Answer

I'd reply to your friend with a Medicare Advantage plan by saying: With a Medigap plan, you're free from copays at the doctors and specialists office, and depending on which Medigap plan you have, you don't have to worry about out of pocket costs for hospitalizations.

Answered by Denise Berg on April 4, 2025

Broker Licensed in CO, AL, AZ & 15 other states

Answered by Denise Berg Medicare Insurance Agent

Fred Manas · Answer

Medicare provides multiple choices from which to choose. The selection process is tailored to the clients needs and wants. Medicare also allows, through certain rules and time periods, for a subscriber to switch from one program to another.

Answered by Fred Manas on April 17, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Steve Brauer · Answer

You can first tell him that nothing is free. Your Medicare Advantage plan may not have a monthly premium, but instead you'll have copays for services that you need, its kind of a pay as you go model. The MediGap plans are designed so that you pay a monthly premium up front, whether you use services or not, and then when you DO use services they are very low cost or free.

Answered by Steve Brauer on April 14, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Robert Remin · Answer

Robert Remin, expert Medicare Plan Adviser. Certified by Medicare and the carriers I represent in NY, CT, NJ and FL. 
Advise your neighbor although there is possibly no premium with many Advantage plans there are copays that could very well approach the plan's maximum out of pocket amount in a bad health year. That does not mean an Advantage plan does not work well. They do when explained by an expert adviser so the client understands their medical and financial risks.

Kelly Linster · Answer

It’s a matter of personal preference. Free as in premium free doesn’t mean free when needing health care. You pay for what you get. You have very robust coverage with Medigap plan. Fortunately, you pay a premium to usually have very little costs when you need health care. One shoe doesn’t fit all!!

Answered by Kelly Linster on May 19, 2025

Agent Licensed in ND, AZ, CO, IA & SD

Answered by Kelly Linster Medicare Insurance Agent

Charles Borg · Answer

He’s wrong. His Medicare Advantage plan has many restrictions that your plan doesn’t. He needs referrals from his primary care doctor before he can see any specialists, and only those that are in list of participating doctors. You don’t have that. You can see any physician who is taking new patients without a referral. No restricted list like in an Advantage plan.

Answered by Charles Borg on June 9, 2025

Agent Licensed in FL & NY

Answered by Charles Borg Medicare Insurance Agent

Robert Baez · Answer

You shouldn't tell your neighbor anything.  Reach out to me so we can do a review and find the right plan for you.

Andy Kelly · Answer

Medigap plans ensure that you know "exactly" what your out-of-pocket costs will be each year, and you get to see any doctor in America who accepts Medicare. Medicare Advantage may have a zero-premium plan, but they also are likely to have a significant "maximum annual out of pocket expense" that could range from $7000 to $10000. There are pros/cons to both approaches, but many clients prefer the security and flexibility of their Medigap plan

Answered by Andy Kelly on June 10, 2025

Agent Licensed in WA & OR

Answered by Andy Kelly Medicare Insurance Agent

Judi Norton · Answer

All Medicare Advantage Plans are not "free." They all have copays. It is pay as you go and you will need to meet the Maximum out-of-pocket before the plan pays all the costs. If you spend little time at the doctors, a Medicare Advantage works well. But, if you have health issues and are required to attend a physician on a regular basis, Medigaps are a better choice. Also, if you start with a Medicare Advantage Plan, and you have a rather serious health condition come up, you may not qualify for a Medigap later on. Medigap plans travel well in that any place that Medicare is accepted, you can go. It even moves with you from State to State. Medicare Advantage Plans have to be changed; i.e., zip code change. Each individual is different and needs to be fit for that individual. Neighbors don't always know all the circumstances surrounding an individual.

Answered by Judi Norton on April 14, 2025

Agent Licensed in NM

Answered by Judi Norton Medicare Insurance Agent

Hector Vazquez · Answer

You are not crazy, every person has different needs, priorities and budgets. Free doesn't mean best or always better. Free is actually never "Free" because we all have been paying Medicare taxes from the very first moment we started working in the US. 

It is wise to consider an Advantage but never make your decision based on someone else's perspective or ideology.

Mitchell Nunn · Answer

Medicare, like many other things in retirement, is not a one size fits all solution. Each person needs to look at their specific situation and the ALL the options available in order to make the best decision for them and their family.

Answered by Mitchell Nunn on June 4, 2025

Broker Licensed in FL, MA & NC

Answered by Mitchell Nunn Medicare Insurance Agent

Chris Prang · Answer

My initial response is to tell them their extremely misinformed and naïve, but that won’t get you anywhere with them. 

First, what is right or works well for one person does not mean it’s going to work well for another person. Medicare Advantage does truly work well for many people, but certainly not all. 

There’s no such thing as truly “free” Medicare Advantage plan. You can get pretty close if you have a good Part B giveback, and a low MOOP (max out-of-pocket), but that’s a small percentage of MA plans. You can also be close to “free” if you have Medicaid and Medicaid is paying the deductibles, copays, and coinsurance. 

So, ask them what their MOOP is? The MOOP is their Financial Risk Exposure...the most that they will have to pay out of their own pocket in a calendar year. The average MA plan has a MOOP of around $5,400 per year.

Let’s suppose you have a Medicare Supplement Plan G, and you are paying $200 per month for it or $2,400 per year. Add in your Part B deductible of $257 and say a Part D drug plan for $25 per month or $300 per year, and now you have a grand total of $2,957 out-of-pocket for the year. So your Financial Risk Exposure is $2,957 for the year and theirs is $5,400...$2,443 less than theirs. 

Now ask him which of you is closer to being “free.” 

Next, ask them if they are “free” to see any provider of their choosing. Odds are, they can’t...unless they have a Passive PPO...and there’s not that many of those around. Then let them know with your Medicare Supplement you are “free” to choose any provider that takes Medicare Assignment...which is 95-98% of them. 

And lastly, ask them if they are “free” to have any Medicare approved procedure. If they don’t know, then inform them, that they are not “free” to have any Medicare approved procedure and could be subject to Prior Approvals and benefit denials at a far greater rate than Original Medicare and your Medicare Supplement. 

That’s what I would tell them or ask them. 

Regards,

Chris Prang

Justin Hundley · Answer

The truth is that there are advantages and disadvantages to both products. While Medicare advantage can often have $0 to very low monthly premiums, it is accompanied by potential out of pocket costs such as copays or coinsurance. A Medicare supplement typically has higher premiums, but often results in much less out of pocket when going to the doctor or into a hospital. 

The best advice I can offer is to schedule a time to speak to a licensed Medicare agent so that they can review your situation and help you determine which product would work best for you.

Sean Krause · Answer

I’d tell him that one size doesnt fit all. That your needs may be different than his. Thats why there’s both kinds of plans.

Curtis Stoner · Answer

Everyone had their own needs when it comes to Medicare. An advantage plan may work best for your neighbor but that doesn’t necessarily mean it will be your best option. My best advice is to educate yourself on how they work or meet with a broker who can explain differences between a medigap and an advantage plan

Answered by Curtis Stoner on May 3, 2025

Broker Licensed in TN, KY & LA

Answered by Curtis Stoner Medicare Insurance Agent

Rick Ried · Answer

Medigap provides very comprehensive coverage for medical care.  It does not provide dental,vision, hearing or prescription drugs.   These coverages must be purchased separately.   

This leads to medigap plans being expensive in comparison to Medicare advantage plans that often cover these items at little to no additional cost.

Both are viable ways to access your Medicare benefits.

Aaron Green · Answer

Supplements and Medicare Advantage are equally beneficial. It’s a matter of individual need and budgeting preference. Simply put, a supplement incurs a monthly premium in exchange for coverage of copays and coinsurances relative to the given letter plan. Some Advantage plans do not have monthly premiums in exchange that you do have to pay set copays and coinsurances. In most cases there is a dental, vision and hearing benefit associated with Advantage plans that are not covered by supplements.

Answered by Aaron Green on April 21, 2025

Broker Licensed in IA, KS, MO & NE

Answered by Aaron Green Medicare Insurance Agent

Tom Perrucci · Answer

Advantage Plans are not free, there are copays , coinsurances when you utilize the services. What you pay for a plan is only one aspect, there are other things to consider. Your coverage, your doctors, network, your health, risk personality as well as your budget.

Answered by Tom Perrucci on April 21, 2025

Agent Licensed in IL, FL, IA & 8 other states

Answered by Tom Perrucci Medicare Insurance Agent

My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?

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My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?

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