My mom called me three times last week about Medicare. She’s turning 65 next month and completely overwhelmed by the choices.
“Do I want Advantage or Supplement? What’s the difference? Everyone keeps telling me different things.”
Yeah, Medicare is confusing. And the decision between Medicare Advantage and Medicare Supplement is probably the biggest choice you’ll make when you sign up.
So let me break it down in plain English. No insurance jargon. Just what you actually need to know.
The Basic Difference Between Medicare Advantage and Medicare Supplement
Medicare Advantage replaces Original Medicare. You get Parts A and B coverage through a private insurance company instead of directly from the government.
Medicare Supplement works alongside Original Medicare. You keep your government coverage and add a private policy to fill the gaps.
That’s the core difference. One replaces, one supplements.
But that simple difference creates a cascade of other differences in how you use your coverage, what you pay, and where you can get care.
Medicare Advantage in 2025
About 51% of Medicare beneficiaries chose Medicare Advantage in 2025. That’s over 35 million people.
The big selling point is the extras. Most Medicare Advantage plans include prescription drug coverage. Many add dental, vision, hearing. Some even throw in gym memberships and transportation to doctor appointments.
And the premiums look attractive. About 76% of people in Medicare Advantage plans pay zero dollars in additional premiums beyond their Part B premium.
Sounds great, right?
Here’s the catch. You’re trading freedom for those perks.
Medicare Advantage plans use provider networks. Most are HMOs that only cover in-network care except for emergencies. Some are PPOs that let you go out of network, but you’ll pay more.
You might need referrals to see specialists. And here’s what really frustrates people: prior authorization.
Your doctor wants to order an MRI? The insurance company has to approve it first. Want a specific medication? Better check if it requires prior authorization.
That layer of insurance company decision making annoys a lot of people. Your doctor doesn’t just order what you need. They have to ask permission.
What You Actually Pay with Medicare Advantage
The zero dollar premium sounds amazing until you start using your coverage.
You’ll pay copays for doctor visits. Maybe $20 for a primary care visit, $50 for a specialist. Hospital stays have copays or coinsurance. Every service has a cost.
The good news is there’s a cap. In 2025, Medicare Advantage plans can’t charge more than $9,350 out of pocket for in-network care. Some plans have lower caps.
If you get really sick and hit that maximum, you’re done paying for the year. That’s protection Original Medicare doesn’t offer.
But if you’re healthy and barely use your coverage, those copays add up anyway.
Medicare Supplement in 2025
Medicare Supplement takes a completely different approach.
You keep Original Medicare. The government pays your hospital and doctor bills directly. Then your Supplement plan pays most of what Medicare doesn’t cover.
The big advantage is freedom. You can see any doctor in America who accepts Medicare. No networks. No referrals. No prior authorization.
If your doctor says you need an MRI, you get an MRI. No insurance company gets between you and your care.
Medicare Supplement plans are standardized. Plan G from one company offers the same benefits as Plan G from another company. Only the price differs.
That makes shopping simple. You’re comparing apples to apples.
What You Actually Pay with Medicare Supplement
Here’s where Supplement plans flip the script. You pay more up front, less when you use care.
Monthly premiums vary by age, location, and which plan you choose. But they’re typically higher than Medicare Advantage premiums. Could be $100 to $300 per month depending on your situation.
In exchange, you have almost no out of pocket costs when you get care. Most Supplement plans cover your deductibles and the 20% coinsurance that Original Medicare leaves you with.
Go to the doctor? Covered. Hospital stay? Covered. No copays, no surprise bills.
The trade off is that higher monthly premium. You’re paying for predictability and freedom.
The Prescription Drug Coverage Question
Most Medicare Advantage plans include Part D prescription drug coverage. That’s convenient. One plan handles everything.
Medicare Supplement plans don’t include drug coverage. You need to buy a separate Part D plan if you take medications.
That’s an extra premium. Average Part D premium is about $46.50 per month in 2025.
But here’s the good news for 2025. All Part D plans now cap out of pocket drug costs at $2,000 per year. That’s new thanks to the Inflation Reduction Act.
Before 2025, people could spend thousands more than that on medications. The cap is a huge improvement.
Who Does Better with Medicare Advantage?
Medicare Advantage works well if you want everything bundled together and don’t mind using a network.
You might prefer Advantage if you’re relatively healthy and want those extra benefits like dental and vision without buying separate policies.
If you’re on a tight budget and can’t afford a higher monthly premium, the low cost entry point helps.
If you already have doctors you like and they’re all in your plan’s network, the network restriction matters less.
And that out of pocket maximum is real protection if something catastrophic happens. You know your worst case scenario.
Who Does Better with Medicare Supplement?
Medicare Supplement makes sense if you want complete freedom to choose your doctors and want minimal hassle when you need care.
If you travel a lot or split time between two states, Supplement works better. No network means no worries about where you get sick.
If you have serious health conditions and see specialists regularly, you’ll appreciate not dealing with referrals and prior authorization.
If you can afford the higher monthly premium, the predictable costs and freedom of choice might be worth it.
And if you value the relationship with your doctor and want them making medical decisions without insurance company interference, Supplement preserves that.
The Real World Difference
My mom’s friend Betty chose Medicare Advantage. Loves the zero dollar premium and uses the gym benefit religiously.
But last year she needed hip surgery. Her orthopedic surgeon wasn’t in network. She had to switch doctors three months before surgery because the plan wouldn’t cover her preferred surgeon.
That sucked. New doctor meant starting over, new tests, building rapport from scratch.
My uncle Jim has Medicare Supplement Plan G. Pays about $180 per month for it.
He had heart surgery two years ago. Chose his surgeon. Got a second opinion from a specialist in another state. Never saw a bill beyond his Part B deductible.
But he grumbles about that monthly premium every time. $180 is real money on a fixed income.
Both made reasonable choices based on their priorities. Betty wanted low upfront costs and extras. Jim wanted freedom and simplicity.
The Hidden Costs Nobody Mentions
Original Medicare has no out of pocket maximum. If you have catastrophic health problems and don’t have Supplement coverage, you could owe 20% of massive bills.
That’s terrifying. A $100,000 hospital stay means you owe $20,000.
Medicare Advantage caps that risk. Medicare Supplement mostly eliminates it by covering that 20%.
But Medicare Advantage has hidden friction costs. The time you spend fighting for prior authorization. The frustration when your doctor’s referral gets rejected. The hassle of switching doctors if they leave the network.
Medicare Supplement has that steady monthly premium whether you use your coverage or not. In a year you barely see a doctor, you spent thousands on premiums for coverage you didn’t need.
Neither option is perfect. You’re choosing which imperfections you can live with.
Can You Switch Between Them?
Switching from Medicare Supplement to Medicare Advantage is easy. You can do it during the annual enrollment period from October 15 to December 7.
Switching from Medicare Advantage to Medicare Supplement is harder.
You can leave Medicare Advantage during enrollment periods. But getting a Supplement plan isn’t guaranteed.
Insurance companies can make you answer health questions. If you have serious health problems, they might deny you coverage or charge you more.
The exception is your first six months on Medicare Part B. During that window, you have guaranteed issue rights. Insurance companies have to sell you a Supplement plan regardless of your health.
That’s why the initial decision matters so much. Switching later might not be an option.
What Changed in 2025?
The big change is the Part D out of pocket cap. $2,000 maximum on drug costs is a game changer for people on expensive medications.
Medicare Advantage out of pocket maximum stayed at $9,350 for in-network care. That’s the same as 2024.
Part B premium went up to $185 per month. That affects everyone, regardless of which coverage you choose.
The Part B deductible is $257 for 2025. Medicare Supplement Plan G doesn’t cover that deductible, so you pay it out of pocket once per year.
About 42 Medicare Advantage plans are available to the average beneficiary in 2025. That’s a lot of choices. Too many choices, honestly.
The Questions You Should Actually Ask Yourself
Do you have doctors you love and want to keep seeing? Check if they’re in Medicare Advantage networks in your area. If not, Supplement might be better.
How’s your health? If you’re dealing with chronic conditions and see specialists regularly, the freedom of Supplement could save you headaches.
What’s your budget? Can you afford $150 to $250 per month for Supplement premiums, or do you need to keep monthly costs lower?
Do you travel? If you spend winters in Florida and summers in Michigan, Supplement’s nationwide coverage matters.
How much do you value simplicity? Medicare Advantage bundles everything but adds complexity with networks and authorizations. Supplement is simple but costs more.
What makes you more anxious? Unpredictable costs when you need care, or fixed monthly premiums whether you use coverage or not?
Common Myths About Both Plans
Myth: Medicare Advantage is free. Not really. You still pay Part B premiums, plus copays for everything you use. Some plans do have zero additional premium, but that’s different from free.
Myth: Medicare Supplement covers everything. Nope. Doesn’t cover prescriptions, dental, vision, or hearing. You pay separately for those.
Myth: You can switch anytime. Not true. Both have specific enrollment periods. Missing them means you’re stuck for a year.
Myth: All Medicare Advantage plans are HMOs. Many are, but PPO plans exist too. They cost more but offer more flexibility.
Myth: Medicare Supplement is only for wealthy people. It’s more expensive, but plenty of middle income folks choose it because they value the freedom and predictability.
What I Told My Mom
After three phone calls and two hours of explanation, here’s what I said.
“Do you want to keep Dr. Martinez?” She loves her primary care doctor. Been seeing him for 15 years.
“Yes, absolutely.”
“Is he in the Medicare Advantage networks available where you live?”
Turns out, no. He accepts Medicare but isn’t in any Advantage networks.
“Then you probably want Medicare Supplement. You’ll pay more monthly, but you keep your doctor and never worry about networks or referrals.”
For her, that relationship with her doctor mattered most. She went with Plan G.
Your priorities might be completely different. That’s fine. Neither choice is wrong.
Frequently Asked Questions
Can you have both Medicare Advantage and Medicare Supplement?
No. It’s illegal for insurance companies to sell you a Medicare Supplement plan if you’re enrolled in Medicare Advantage. You have to pick one or the other.
What happens if you move to a different state?
With Medicare Supplement, you keep your coverage nationwide. With Medicare Advantage, you might lose coverage if you move outside your plan’s service area. You’d need to enroll in a new plan in your new location.
Do Medicare Advantage plans really deny care?
They can deny prior authorization requests if they determine the care isn’t medically necessary. Your doctor can appeal, but it adds time and hassle. This is one of the biggest complaints about Medicare Advantage.
Is Medicare Supplement worth the cost?
Depends on your situation. If you value freedom to choose doctors, travel frequently, or have serious health conditions, many people find the premium worth it. If you’re healthy and prefer lower monthly costs, maybe not.
Can you switch from Medicare Advantage to Original Medicare?
Yes, during specific enrollment periods. But getting a Medicare Supplement plan to go with it might be difficult if you have health problems and you’re outside your guaranteed issue period.
What’s the best Medicare Supplement plan?
Plan G is the most popular for people who became eligible for Medicare after 2020. It covers almost everything except the Part B deductible. Plan N is cheaper but has small copays. The “best” depends on your budget and preferences.
The Bottom Line
Neither Medicare Advantage nor Medicare Supplement is objectively better. They’re designed for different priorities.
Medicare Advantage offers lower upfront costs, extra benefits, and bundled coverage. You trade freedom and simplicity for those perks.
Medicare Supplement offers complete freedom to choose doctors, minimal hassle when you need care, and predictable costs. You pay for that with higher monthly premiums.
If you want the lowest possible monthly costs and don’t mind networks, Medicare Advantage might work.
If you want to see any doctor, avoid insurance company interference, and prefer predictable expenses, Medicare Supplement might be better.
But here’s what really matters. Make your decision during your initial enrollment period when you have guaranteed issue rights for Supplement plans.
Waiting until later might lock you into Medicare Advantage if your health declines and Supplement companies won’t cover you.
Talk to a licensed insurance agent who can show you actual plans in your area. Look at the provider networks. Calculate your actual costs based on your health needs.
Don’t just grab the plan with the flashiest ad or the lowest premium. Think about how you actually use healthcare and what matters most to you.
My mom went with Supplement because keeping her doctor mattered more than saving money on premiums. Your calculation might be completely different.
Just make sure you’re choosing based on your actual priorities, not someone else’s sales pitch.
