Key Takeaways
- Medigap (Medicare Supplement) is extra private insurance that helps with deductibles, coinsurance, and copays under Original Medicare (Parts A and B)—not a substitute for Parts A and B.
- Medicare Advantage (Part C) is another way to get Part A and Part B through a Medicare-approved private plan, often with Part D included and a yearly MOOP (maximum out-of-pocket) for covered Part A and B services.
- When you are getting started, Medicare says you can either buy Medigap or join a Medicare Advantage Plan—you cannot have both, and you cannot use Medigap to pay Medicare Advantage copayments, deductibles, or premiums.
- In Brooklyn and NYC, plans, premiums, and networks depend on your county and ZIP code and change each year—always confirm doctors, drugs, and costs in official plan documents and Medicare Plan Compare.
If you are searching the official CMS name—Medicare Supplement Insurance—you are in the right topic area: Medigap is the everyday nickname for the same product. For a parallel article that leads with Medicare Supplement wording and standardized plan letters, see Medicare Supplement vs Medicare Advantage.
- What Is Medigap (Medicare Supplement Insurance)?
- What Is Medicare Advantage (Part C)?
- Medigap vs Medicare Advantage at a Glance
- Monthly Costs: Premiums, Deductibles, and Predictability
- Doctors, Networks, and Getting Care From NYC
- Prescription Drugs: Medigap Plus Part D vs Bundled MA-PD
- Switching Paths, Trial Rights, and Why Timing Matters
- Frequently Asked Questions
- Take the Next Step
Medigap is the common name for Medicare Supplement Insurance. Generally, you must have Part A and Part B to buy a Medigap policy. After Medicare pays its share of the Medicare-approved amount for a covered service, your Medigap policy may pay part or all of what you would otherwise owe under the standardized benefits for the plan letter you choose—subject to the policy’s terms.
Per Medicare.gov — Learn how Medigap works, a few structural rules are easy to overlook: each Medigap policy covers only one person, so spouses who both want Medigap each buy their own policy; standardized Medigap policies renew automatically each year even if your health changes; and the insurer can end coverage only in limited situations—such as nonpayment of premiums, material misrepresentation on the application, or the company becoming insolvent (always read your contract and state notices).
Medigap works with Original Medicare. It is not drug coverage for most new policies: Medigap plans sold after 2005 do not include prescription drug coverage (so new Medigap enrollees typically add Part D separately). If you want drug coverage, you typically join a separate Part D plan. Official overview: What’s Medicare Supplement Insurance (Medigap)?
Medicare also notes that if you buy Medigap and Part D from the same company, you may need to make two separate premium payments—confirm billing with the insurer. Source: same Medigap & Medicare Advantage Plans page under Medigap & prescription drug coverage.
If you are still mapping how Parts A–D fit together, our Medicare Parts A–D costs for 2026 article lists current Part B premium and deductible figures from CMS and explains how MOOP on Medicare Advantage differs from no yearly cap on Parts A and B alone.
Medicare Advantage is Part C. If you have Part A and Part B, you can join a plan offered by a Medicare-approved private company that must follow Medicare’s rules. The plan is another way to get your Part A and Part B benefits instead of receiving them directly through Original Medicare for covered services, with cost-sharing and network rules set by the plan. Most Medicare Advantage plans include Part D. See Your health plan options.
For how Part C fits local options, read our Medicare Advantage overview. That page connects to enrollment periods and plan types (such as HMO and PPO) you will see when you shop by ZIP code.
Use this table as a starting frame. Your premiums, cost-sharing, drug coverage, and access rules depend on the specific Medigap letter, Part D plan, or Medicare Advantage contract available in your county for the plan year.
| Topic | Medigap (with Original Medicare) | Medicare Advantage (Part C) |
|---|---|---|
| What it is | Extra policy that helps pay some Original Medicare out-of-pocket costs | Medicare health plan that delivers Part A and Part B (and usually Part D) |
| Works with | Original Medicare (Parts A and B) | Replaces how you receive Part A and B benefits for covered care (you stay in Medicare) |
| Typical drug coverage | Separate Part D plan (Medigap policies sold after 2005 do not include drug coverage, per Medicare.gov) | Often included (check formulary) |
| Provider access | Broad access to providers that accept Medicare nationwide (Medigap does not replace Medicare’s provider rules) | Plan networks (HMO, PPO, etc.); out-of-network rules and emergency coverage depend on plan type |
| Out-of-pocket limit (Part A and B services) | No Medicare cap on your share for Parts A and B—Medigap may reduce what you pay, depending on the letter | Plans must have a yearly MOOP for covered Part A and B services (amount varies) |
| Extra benefits | Medigap does not add dental, vision, etc. (you may buy separate insurance) | Plans may offer extra benefits that vary by contract and year—read the Evidence of Coverage |
Medicare states clearly that Medigap is different from Medicare Advantage: a Medigap policy supplements Original Medicare, while Medicare Advantage is another way to get Medicare coverage—and you can’t have both when you are first choosing your path. Source: Learn how Medigap works.
With Original Medicare plus Medigap and Part D, you often pay several separate premiums: Part B (and Part A if it applies), Medigap, and Part D. You also face Original Medicare’s deductibles and coinsurance, though a Medigap policy may cover much of that share depending on the plan letter. For 2026, CMS announced a standard monthly Part B premium of $202.90 and a Part B annual deductible of $283—see the CMS fact sheet 2026 Medicare Parts A & B Premiums and Deductibles. Higher incomes may pay more under IRMAA rules in that same official source.
With Medicare Advantage, you must keep paying your Part B premium (unless Medicaid or another program pays it for you). The plan may charge a plan premium or show $0 premium options in some areas—$0 premium does not mean zero costs. You still pay copays, coinsurance, and other cost-sharing until you hit the plan’s MOOP for covered Part A and B services, and drug costs follow the plan’s Part D design. Dual-eligible New Yorkers may have different help with premiums and cost-sharing; start with D-SNP plans and Medicare’s SNP overview if Medicare and Medicaid both apply.
Need help comparing paths for your doctors and drugs? Call SJM Cares at (347) 696-6757 for a free, no-obligation conversation with a licensed Medicare advisor in Brooklyn.
Original Medicare with Medigap is often chosen by people who want to see a wide range of specialists and hospitals that accept Medicare—helpful if you receive care in more than one borough, split time between New York and another state, or want fewer prior authorization steps for many services (Medicare’s rules still apply; Medigap does not remove Medicare coverage limits).
Medicare Advantage fits some households when local networks include their primary care doctor, specialists, and preferred hospitals for the entire plan year, and when copay-style cost-sharing is easier to budget than coinsurance on Part B services. Before you enroll, use the plan’s provider directory and Medicare Plan Compare—networks can change.
For a broader Original Medicare vs Part C framing (including travel notes), see Medicare Advantage vs Original Medicare: A Plain-Language NYC Guide.
If you choose Original Medicare and Medigap, you usually add a standalone Part D plan for outpatient prescriptions. You will compare formularies, tiers, pharmacies, and deductibles each year during Fall Open Enrollment (generally October 15–December 7) when you want to make voluntary drug-plan changes, unless you qualify for a Special Enrollment Period. Our AEP vs OEP vs SEP for NYC article summarizes the main windows with links to Medicare.
If you choose Medicare Advantage with drug coverage (MA-PD), Part D is bundled into one card and one member handbook—but formulary and utilization rules are still plan-specific. Eye drops, inhalers, and insulin can be priced on different tiers in two plans in the same ZIP code, so do not assume two “similar” plans match on drug costs.
Medicare describes several situations where people move between Medicare Advantage and Original Medicare and try to add or restore Medigap. Rights to buy a Medigap policy without medical underwriting depend on state law and your situation—New York has its own insurance rules for how Medigap is marketed and renewed; for personal rights and deadlines, use SHIP (SHIP Help) or review Medicare’s pages on when you can join, switch, or drop a plan.
Official Medicare highlights include: you cannot buy Medigap while you are in a Medicare Advantage Plan unless you are switching back to Original Medicare; you cannot use Medigap to pay Medicare Advantage cost-sharing; a 12-month trial right may apply when you drop Medigap to join a Medicare Advantage Plan for the first time (whether you can get the same Medigap back depends on the insurer still selling that policy and state law); and if you joined Medicare Advantage when you were first eligible for Part A at age 65, you may be able to buy certain Medigap policies your state allows if you switch back to Original Medicare within the first year—again, details depend on state law and your timeline. Read the exact conditions on Learn how Medigap works.
If you already have Part C and want to understand January–March options to change plans or return toward Original Medicare, confirm the current rules for Medicare Advantage Open Enrollment on Medicare.gov for the year you are in—dates and allowed moves can be updated.
No for how people usually mean “having both.” Medicare says when you are getting started, you can either buy Medigap or enroll in a Medicare Advantage Plan—not both. You cannot use Medigap to pay Medicare Advantage copayments, deductibles, or premiums. Source: Medigap & Medicare Advantage Plans.
No. Medigap supplements Original Medicare cost-sharing. Medicare Advantage is Part C—a different delivery system for Part A and Part B with plan networks and annual limits for covered services. Compare the definitions on Medicare.gov — Medigap basics and Your health plan options.
There is no universal answer. Medigap often means higher monthly premiums but more predictable help with Part A and Part B cost-sharing when paired with a comprehensive letter plan. Medicare Advantage may show lower advertised premiums in some areas but still includes copays and a MOOP. Your drugs, doctors, and health use determine the total cost picture—use Medicare Plan Compare.
Medigap policies sold after 2005 do not include prescription drug coverage in the way Part D does. You typically add Part D. If you have an older policy that still includes drug coverage, Medicare recommends talking with your state’s insurance department about your options—see Medigap & prescription drug coverage.
Yes. Medicare Advantage plan availability is by service area (often county-based). Medigap premiums and which insurers sell which standardized plans also vary by location and rating method. Always shop using your ZIP code and the plan year.
Sometimes, during an election period or a Special Enrollment Period if you qualify. After you return to Original Medicare, whether you can buy Medigap on guaranteed-issue terms depends on New York rules and your personal timeline—this is a common place to involve SHIP or a licensed advisor. Start with Medicare’s switching pages linked from when you can join, switch, or drop a plan.
Choosing between Medigap (with Original Medicare) and Medicare Advantage is personal: it depends on your doctors, drugs, budget, travel, and tolerance for network rules. For the same topic using Medicare Supplement language and a plan-letter overview, read Medicare Supplement vs Medicare Advantage.
SJM Cares helps Brooklyn and NYC residents compare Medicare Advantage and D-SNP options we are appointed to discuss—education first, then next steps that fit you.
Call us at (347) 696-6757 or schedule an appointment online. For broader NYC resources, visit our Community Resource Hub.
Written by Hamad Amir, licensed insurance agent and founder of SJM Insurance Services, LLC. Licensed in New York and New Jersey (License #LB-1024797). Specializing in Medicare Advantage and D-SNP plans for Brooklyn and NYC residents.
Hero photo is a stock image from Unsplash for illustration only; it does not depict a specific plan, carrier, or government program.
Disclaimer: This article is for educational and informational purposes only and does not constitute professional insurance, financial, or legal advice. For personalized guidance, call a licensed SJM Cares advisor at 917-373-0117.
We do not offer every plan available in your area. Currently we represent 10 organizations which offer Medicare Advantage HMO, PPO, PFFS, and PDP plans in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY: 1-877-486-2048), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
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