Pop quiz: Should you get Medicare Advantage or Medigap?

Approaching 65 and puzzling over your Medicare options? Answer these 10 questions to discover if you’re a better candidate for Medicare Advantage or Medigap.

When it comes to handling family finances, which of the following describes you best?

a. Poring over budgets and bills gives me a headache. I’d rather have my teeth drilled.

b. I tend to procrastinate, but once I get into bill-paying mode, I really don’t mind.

c. All of my household finances are on a spreadsheet that I update on the first of every month.

What’s your health insurance budget?

a. I want to keep monthly premiums to a minimum. I like having money left over for fun. 

b. I’m budget conscious, but low cost isn’t my top priority.

c. I’ve been fortunate. Money is no object

How connected are you to your doctor and local health system?

a. Each time I go for a visit, I see a different provider, so I’m not attached to any particular doc.

b. I like my doctor OK, but I’m open to finding a new one.

c. My doctor’s been taking care of me for years. Don’t make me change!

How important is exercise to you?

a. I hit the gym every chance I get. But membership is getting expensive.

b. I take a yoga class once in a while.

c. I get my exercise working in the garden and shopping at the mall.

Do you get to the eye doctor regularly?

a. My vision’s not so hot, but glasses are pricey, so I don’t go as often as I should.

b. I go every couple of years to economize.

c. I like to keep my vision sharp, so I get a new pair of glasses every year.

How’s your hearing?

a. What?

b. It’s starting to go south, so I’m putting money aside for hearing aids. They’re expensive!

c. I can hear a whisper from the next room. It’s my superpower.

Do you keep up with regular dental visits?

a. I try—but x-rays and exams are pretty pricey. I usually get there every other year.

b. I usually get to the dentist yearly, before little problems become big, expensive ones.  

c. I’m in the chair every six months, come what may. I never miss a checkup.

Any hospital stays in your future?

a. My doc says I’m headed for double hip-replacement surgery before too long.

b. I’ve got a couple of health conditions, but nothing that’ll send me to the hospital. 

c. I’m lucky. Haven’t had a hospital stay in forever, and I have none planned. 

What about prescription drugs?

a. My medicine cabinet is overflowing—and my prescriptions are eating into my budget.

b. I take a couple of medications, but they’re not too expensive. 

c. I don’t need much in the way of medication.  

Do you like surprises?

a. I have no tolerance for unexpected events—they send me into a panic.

b. I like to plan, but when surprises come I can usually handle it. 

c. I’m OK with the unexpected. It doesn’t freak me out.

Scoring: Give yourself 10 points for each (a) answer, 5 points for each (b), and 1 point for each (c). Tally up your score to see if a Medicare Advantage plan might be right for you, or if Medigap makes more sense.

60–100:  Looks like you pinch your pennies—and you like simplicity and savings. This means a Medicare Advantage (MA) plan might be just the choice for you. It’s a lot like the plan you might have had at work through your employer, with coverage for most of your health needs.

“With Medicare Advantage plans, lots of people pay small premiums—or sometimes no premiums at all,” explains Andrew Shea, vice president of eHealth Medicare, a company that helps people pick Medicare plans. “Every plan is different, but Medicare Advantage offers lots of choices and options, including dental and vision insurance.”

There are lots of Medicare Advantage plans to choose from, offered by a variety of insurance companies. The plans typically have co-payments, coinsurance, and sometimes deductibles. While some have no monthly plan premium, others may cost around $50 a month.

The downside? You can’t just shop around for your favorite doctor. Medicare Advantage Plans (HMO and PPO), usually include a specific network of doctors and health care facilities. So, before you make a decision, be sure to check that you’re OK with the doctors and hospitals in the plan. And if you split your year in different places—or you’ve got international travel plans—read the fine print closely. Check to make sure that your Medicare Advantage coverage goes with you. Some plans do, and others don’t. 

10–59 points: You’re likely super organized: You stay on top of your health appointments and you’re great at planning ahead. You don’t spend extravagantly—but you don’t have to pinch your pennies either. Plus, you may have been blessed with pretty good health. Looks like a Medigap plan might be the way to go. 

Since basic Medicare doesn’t cover 100 percent of your health care costs, a Medicare Supplement—Medigap—is another type of Medicare insurance plan that you may want to consider. One negative with Medigap: You have to find separate prescription coverage. (For that, consider a Part D Medicare plan.) But there are pluses, too. 

With Medicare supplement plans, you have the freedom to choose any provider who accepts Medicare. “You won’t be locked into doctors, hospitals, and even pharmacies in a specific network,” says Daks Hamner, director at Guardian Pharmacy Services. “It allows you a little more flexibility.” 

The flexibility of Medigap comes with a price. As always with pricing, there’s lots of variability—depending on where you live and how old you are. And if you’re healthy, you may be able to choose a Medigap plan with premiums that are more competitive with MA. But overall, in most cases, you’ll likely pay more than with Medicare Advantage. 

“A Medicare supplement has a higher monthly premium, ranging from about $50 to about $400 a month, depending on which plan you choose and which benefits you need,” says Kerri Lenderman, an insurance expert with MedicareCompareUSA. “That’s significantly more expensive than most Advantage plan premiums, and you’ll still need to purchase a stand-alone Medicare prescription plan if you want coverage for your drugs.” The premium for a stand-alone Medicare prescription plan can run you anywhere from $7 to $100 a month, in addition to the medication copayments.