What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?

Question

Craig Kirscht · Accepted Answer

To help someone choose between Medicare Advantage and Medigap, I ask:
Health Usage: Frequent doctor visits or chronic conditions? → Medigap.
Budget: Want low monthly premiums? → Medicare Advantage. Prefer predictable costs? → Medigap.
Doctor Choice & Travel: Want nationwide coverage and keep any doctor? → Medigap. Okay with networks? → Medicare Advantage.
Drug Coverage: Want it included? → Medicare Advantage. Don’t mind a separate plan? → Medigap.
Simplicity: Want one bundled plan? → Medicare Advantage. Don’t mind piecing it together? → Medigap.

It's important to have a conversation going over all of this and find out what fits best for each individual. There are lots of plans out there with different benefits. Not all may fit your needs.

Lt Col Tim Brown · Answer

Explaining how supplements and advantage plans work. While you want me to make recommendations, it is important that people understand how the plans work. Doing that helps clients determine what is best for them.

Answered by Lt Col Tim Brown on May 31, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Norman Smith · Answer

Explaining the hat you are giving up by taking an MA instead of a Medigap plan. You do not have control of your health. Instead you give to a corporate guy in a high rise smoking a nice cigar, who can approve or disapprove of your coverage. 
You give up the rights to the best doctors and facilities across the country wherever you are in the country! Not with your MA plan! Better be In Network! And for the most part going a county or 2 outside your region and you have no one in Network!
Get the Best while you can before they lessen the benefits of the best plan by removing it as a choice! They have consistently managed to put more and more responsibility on the policy holder and less for the government to have to pay. So think about it!

Tony Capraro III · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/whats-your-go-to-strategy-for-helping-someone-decide-between-medicare-advantage-and-medigap#tony-capraro

Charise Karjala · Answer

I have a seven question algorythm that is 99% accurate.  Seven questions and the appropriate strategy is evident.

Steven Whetstine · Answer

When choosing Medicare options, it is important to know what is important to the Medicare Beneficiary and Healthcare needs.

Some factors may include health risks and needs, financial concerns, lifestyle preferences and how one chooses to receive treatment or care.

For example, if your preference is to receive care through the Mayo Clinic, the Mayo Clinic only accepts original Medicare and Medicare Supplement or Medigap Plans.  They do not accept Medicare Advantage Plans.

If you like to travel or reside in more than one state in the year, then Medicare Supplement or Medigap plans typically make more sense.  You are not limited to a network and can receive your medical care anywhere.  With a Medicare Advantage plan, you typically have to wait until you get back to your local area within your network unless it is a medical emergency.

If someone has a chronic or severe condition, I evaluate their situation.  Is it during their initial enrollment period?  That has to be considered as there are no underwriting questions for a Medicare Supplement Plan or Medigap Plan and factor high utilization.  Otherwise, a chronic special needs plan may be appropriate for the person if they meet the criteria for the plan.

If one would like more flexibility in their care, a Medicare Supplement or Medigap plan may make sense because you do not have to get a referral and you can see any medical professional or visit any facility as long as they accept Medicare whereas you have to verify that your medical professionals and facilities are within the network with a Medicare Advantage plan.  

Would you prefer to pay a higher premium with less out of pocket expenses, or would you rather have no premium or much smaller premium and pay the out-of-pocket expenses as you utilize the plan?  

There are many things to consider when choosing the appropriate Medicare plan for you!

Christy Jones · Answer

I go over both types of plans and we talk about all of the differences between them. We discuss their current health needs as well as the cost differences between the two types of plans. How will they use their plan? How much do they want to spend on a plan? I have clients on both Medicare Supplements as well as Medicare Advantage plans, and my goal is to have a happy client.

Answered by Christy Jones on May 31, 2025

Broker Licensed in ID, AL, AR & 20 other states

Answered by Christy Jones Medicare Insurance Agent

Anthony Castelluccio · Answer

I really don't have a strategy to help someone decide Medicare Advantage vs Original Medicare. I always explain all of the details about both options. The 2 big differences are Medicare Advantage you should stay in network and if you have some chronic conditions then you could pay a lot more out of pocket then Original Medicare plus a supplement. Also if you are on a Medicare Advantage for more than 12 months you may not be able to qualify to get into a Medicare Supplemental plan. Many people i meet don't know that and are stuck paying a lot for their health care.

Answered by Anthony Castelluccio on April 12, 2025

Agent Licensed in PA, DE, MD, NJ & VA

Answered by Anthony Castelluccio Medicare Insurance Agent

Tammera Marrs · Answer

Presenting both Medicare Advantage and Medicare Supplement options is how we help clients decide. Normally during our presentation the client has a definite decision before we are even done presenting. We feel education is the best option

Answered by Tammera Marrs on May 1, 2025

Broker Licensed in KS

Answered by Tammera Marrs Medicare Insurance Agent

Keaton Lewis · Answer

When explaining the differences between the two, I like to say the Medigap is the "prepay" option and Medicare Advantage is the "pay as you go" option. If a client knows they are going to have some serious health issues and lots of medical care, i would recommend the Medigap route. However if they are pretty healthy and especially if they are looking to save money, I usually recommend Medicare Advantage, so they can "pay as they go" instead of paying up front whether or not they need it.

Answered by Keaton Lewis on May 5, 2025

Broker Licensed in ID, AZ, CA & 11 other states

Answered by Keaton Lewis Medicare Insurance Agent

Michael Ferraro · Answer

First I make sure they unerstand how Medicare works.

Next I check to see if they can afford a Medicare Supplement.

Then we go over overall health.  Many Dr visits?  Often at a specialist?

I then do a side by side comparison of a med sup and Medicare Advantage plan and explain this is just a general example so you can see how it works.

We then talk about their risk profile and I make a formal recomendation.

Once they choose we put together a list of Dr's and Medications (Even if they are going with Medigap)  and compare plans 

By the end of this process it's usually pretty clear to the client what they should do.

Steven Bleicher · Answer

There are 3 major questions that I pose to everybody who asks this common question. They are:

A) Do you or your spouse have any potentially serious health issues?

B) Do you have a favorable family history of longevity? (mother, father, siblings, etc.)

C) Do you have the finances needed to pay for the monthly premium for a Medigap?

Once I stop talking and allow my clients to ponder all of the above answers, then it is extremely important for me to review all of their implications mentioned by these 3 main questions.  Moreover, if all of the above inquiries "lean toward a negative answer", my diagnosis for this particular client is that a Medigap is the better choice than the free Advantage plan that contains a fairly steep out-of-pocket deductible cost each year.

Michael Yost · Answer

My strategy is to best explain both options to someone and let them decide what is best for them. Medicare is a very complicated system and people need to understand how their plan options work so they can make an informed decision.

Answered by Michael Yost on March 30, 2025

Broker Licensed in OH, AL, AZ & 27 other states

Answered by Michael Yost Medicare Insurance Agent

Aaron Solomon · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/whats-your-go-to-strategy-for-helping-someone-decide-between-medicare-advantage-and-medigap#aaron-solomon

Rene Casanova · Answer

What is most important to the client such as the freedom to go to any doctor or hospital without having to make sure they are in a network or getting a referral to see a specialist, and their budget. If they can afford a Medigap policy and Part D prescription drug plan and want the freedom to choose any doctor they want to see the choice is an easy one.

Answered by Rene Casanova on April 3, 2025

Broker Licensed in TX

Answered by Rene Casanova Medicare Insurance Agent

Denise Berg · Answer

My strategy is to explain each and ask follow up questions like;

a) Do you travel within the US and do you reside in another state for 6 months?
b) Do you want the freedom to see any doctor?
c) How do you feel about copays?
d) Would you rather have one card to access your all of your benefits?
e) Would you prefer not to have a schedule for preventive services that limits exams?

Michael Braden · Answer

I like to ask the prospective client, what their understanding is of both Medicare ADvantage and Original Medicare with adding a Medicare Supplement/Medigap plan.

From there, I just speak with them about their travel plans, will they be staying in their local are primarily, or; do they anticipate traveling, that is when I reiterate the differences with the plans.

Often times Medicare Advantage plans can bea good fit, if the prospect needs/desires the extra benefits taht come with the plans, but they are restrictive.  Then, I draw their attention to the MOOP, that comes with each MA plan,  Explaining that there often times, the MOOP can be 2-4 times more in poteeential out of pocket costs than having Original Medicare with a Supplement.

Lastly, I urge them to spend  time reading teh Explanation of Benefits section of any MA Plan they are considering, so they have a firm understanding of the benefits, and how   they work,

Jennifer Stark · Answer

My go to strategy is to show the difference between the 2 plans. making sure the client understands how they differ in each coverage. Then helping them break down what their personal needs are, and answering all questions they have. From there they can decide what works best for the healthcare needs.

Answered by Jennifer Stark on April 21, 2025

Broker Licensed in WI, CO & FL

Answered by Jennifer Stark Medicare Insurance Agent

Gabrielle Sones · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/whats-your-go-to-strategy-for-helping-someone-decide-between-medicare-advantage-and-medigap#gabrielle-sones

Danielle Moody · Answer

I like to do a thorough needs assessment and go over all options with my clients to determine which plan options are best for their situation. Sometimes, depending on income, travel, and other factors, it makes a big difference.

Answered by Danielle Moody on April 16, 2025

Broker Licensed in FL, AK, AL & 46 other states

Answered by Danielle Moody Medicare Insurance Agent

Roseann Vandevender · Answer

I always list the pros and cons to their personal situation. This helps them make an informed decision. I also stress that a T 65 or First time Part B enrollee has a "freebie in" to any MediGap policy per Medicare rules. if the want to switch at a later date they might not qualify for the coverage.

Answered by Roseann Vandevender on June 2, 2025

Agent Licensed in OH, AZ, CO & TX

Answered by Roseann Vandevender Medicare Insurance Agent

Jessica Yen Le · Answer

It would be depends on each case situation. I believe if you can afford the medigap, go for it, because the cost will increase by you aged. If you cannot, go for advantage, the medical group can follow up with your health journey to make sure you get enough care as well as they have system to avoid the malpractice problems,etc. Each of them have their own pros & cons. So make sure to understand what they are and which one is suitable for your own situation & requirements. Hope each of you get the right plan.

Answered by Jessica Yen Le on June 6, 2025

Broker Licensed in CA, AK, AZ & 21 other states

Answered by Jessica Yen Le Medicare Insurance Agent

DeeDee England · Answer

My strategy for helping someone decide between Medicare Advantage and Medigap would be to first go over how Medicare works. Then I would explain how each of these options works with Original Medicare. I would show them all the options for each of these with the companies available in their area as well as the costs involved.

Answered by DeeDee England on April 22, 2025

Broker Licensed in IA & NE

Answered by DeeDee England Medicare Insurance Agent

What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?

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