Maryland Medicare guide
Medigap or Medicare Advantage?
A neutral guide to providers, networks, premiums, cost sharing, drug coverage, prior authorization, travel, enrollment timing, and annual review.
The short answer
Medigap supplements Original Medicare and can help pay certain remaining Medicare-approved costs; it generally does not include Part D, so drug coverage is commonly separate. Medicare Advantage is another way to receive Medicare-covered services through a private plan and commonly uses networks, plan rules, and an annual maximum out-of-pocket limit. A person generally cannot use both structures at the same time.
What to carry into the decision
Review these points first, then read the sections and official sources before acting.
- Compare Original Medicare plus Medigap and Part D against Medicare Advantage as different coverage structures.
- Verify doctors, hospitals, prescriptions, pharmacies, travel, referrals, and prior authorization using current plan information.
- Medigap plans are standardized by letter, but premiums, underwriting, service, and discounts can vary.
- Medicare Advantage and Part D availability and details vary by county, ZIP code, and year.
- Enrollment and guaranteed-issue rights can materially affect the ability to change later.
Compare the structures before the individual products
General comparison only; current Medicare, state, and plan rules control.
How coverage works
- Original Medicare + Medigap
- Original Medicare pays first; Medigap may help with covered remaining costs under the policy.
- Medicare Advantage
- Private plan provides Medicare-covered Part A and Part B services under plan rules.
Providers
- Original Medicare + Medigap
- Generally any U.S. provider accepting Medicare, subject to Medicare and policy terms.
- Medicare Advantage
- Networks, referrals, service areas, and out-of-network rules vary by plan.
Prescription drugs
- Original Medicare + Medigap
- Usually separate Part D coverage is considered.
- Medicare Advantage
- Often included, but formulary and pharmacy rules vary.
Premiums
- Original Medicare + Medigap
- Part B plus Medigap and commonly Part D premiums; amounts can change.
- Medicare Advantage
- Part B plus any plan premium; zero additional premium does not mean zero cost.
Cost sharing
- Original Medicare + Medigap
- Standardized Medigap benefits may cover specified Original Medicare cost sharing.
- Medicare Advantage
- Copays, coinsurance, deductibles, and an annual medical maximum out-of-pocket vary by plan.
Changing coverage
- Original Medicare + Medigap
- Medigap underwriting or guaranteed-issue rules may affect later enrollment.
- Medicare Advantage
- Medicare enrollment periods and plan availability govern changes.
1. List the providers and care patterns that matter
Confirm current doctors, specialists, hospitals, health systems, therapy, durable medical equipment, and routine travel. Original Medicare provider access and Medicare Advantage network rules operate differently. Never rely only on a directory screenshot; verify with the plan and provider and understand that participation can change.
2. Compare total annual cost—not one premium
Include Part B, Medigap, Part D, Medicare Advantage premiums, deductibles, copays, coinsurance, drug costs, maximum out-of-pocket exposure, non-covered services, travel needs, and likely utilization. A zero additional-premium Medicare Advantage plan is not zero-cost coverage, and a higher Medigap premium does not predict total cost by itself.
3. Review prescriptions and pharmacies separately
Part D and Medicare Advantage drug formularies, tiers, prior authorization, quantity limits, step therapy, preferred pharmacies, and costs can change. Use the current prescription and pharmacy list in Medicare's official Plan Compare tool and review the plan's Annual Notice of Change each year.
4. Understand prior authorization and referrals
Medicare Advantage plans can use prior authorization and network or referral rules under the plan. Original Medicare has its own coverage rules, and Medigap generally follows Medicare-approved services rather than deciding medical coverage independently. Review how each structure affects access and administration.
5. Protect enrollment and Medigap rights
Initial enrollment, Part B timing, Medigap open enrollment, guaranteed-issue rights, trial rights, employer coverage, COBRA, disability status, and state rules can affect options. Do not cancel current coverage until new coverage and effective dates are confirmed through approved channels.
6. Recheck the decision every year where appropriate
Medicare Advantage and Part D plans can change premiums, benefits, networks, formularies, pharmacies, and service areas. Medigap premiums can change even though standardized benefits remain tied to the plan letter. Review current notices and personal needs during the relevant enrollment period.
Related guidance
Continue to the service or decision that best fits your situation.
Sources
- Medicare.gov — MedigapOfficial federal Medicare Supplement information.
- Medicare.gov — Compare Original Medicare and Medicare AdvantageOfficial federal comparison of Medicare coverage paths.
- Medicare.gov — Plan CompareOfficial tool for current plan availability and details by location.
- Maryland Department of Aging — Medicare SupportOfficial Maryland SHIP and Medicare support resources.
Educational information only; not legal, tax, accounting, actuarial, medical, coverage, investment, or compliance advice. Product availability, eligibility, underwriting, pricing, networks, plan terms, and recommendations depend on current facts. Use the contact form for general business information only. Do not include personal health information, claims details, Social Security numbers, member IDs, financial information, or credentials.
Compare the structure using current personal facts
Request a general conversation about timing, coverage structure, providers, and prescription-review steps. Do not enter Medicare numbers, Social Security numbers, medical, prescription, claim, policy, financial, or credential data in the public form.