If you are turning 65 in Texas, or reviewing your Medicare for next year, the biggest choice is between Medicare Advantage and Medicare Supplement (Medigap). Here is how each one works, in plain English, with the real trade-offs.
Start With Original Medicare
Original Medicare is Part A (hospital insurance) and Part B (medical insurance). According to CMS, in 2026:
- Part A: $0 monthly premium for most people, and a $1,736 deductible for each hospital benefit period.
- Part B: a standard premium of $202.90 a month (higher for higher incomes) and a $283 yearly deductible. After that, you usually pay 20% of the Medicare-approved amount.
- No yearly cap: Original Medicare has no limit on what you can pay out of pocket in a year, and it does not cover most prescription drugs, routine dental, vision or hearing.
Those gaps are why most people add either a Medicare Advantage plan or a Medicare Supplement (Medigap) policy with a Part D drug plan.
Option 1: Medicare Advantage (Part C)
Medicare Advantage plans are offered by private insurance companies approved by Medicare. They replace Original Medicare as the way you get your Part A and Part B benefits, and most include Part D drug coverage.
- Cost: many plans have low monthly premiums, but you still pay your Part B premium. You pay copays and coinsurance as you use care.
- Yearly limit: every plan has a maximum out-of-pocket limit for covered services, which Original Medicare does not.
- Networks: most plans are HMOs or PPOs. Going outside the network can cost more or may not be covered.
- Prior authorization: many plans must approve certain services before they are covered.
- Extras: some plans include dental, vision, hearing or other extras. These vary by plan and can change every year.
Option 2: Medicare Supplement (Medigap) + Part D
A Medigap policy is sold by a private insurance company and works alongside Original Medicare. It pays some or all of your Medicare deductibles, copays and coinsurance. You add a separate Part D plan for prescriptions.
- Doctors: you can see any doctor or hospital in the U.S. that accepts Medicare. There is no network.
- Cost: a higher monthly premium than most Advantage plans, in exchange for low and predictable costs when you use care.
- Standard plans: Medigap plans are labeled with letters, and each letter has the same basic benefits no matter which company sells it. Prices differ by company. Plans C and F are not available to people who became eligible for Medicare on or after January 1, 2020.
- Timing matters: your Medigap Open Enrollment Period lasts 6 months, starting the month you are 65 or older and enrolled in Part B. During that window, companies cannot turn you down or charge more because of your health. Outside that window, they generally can.
You cannot use a Medigap policy with a Medicare Advantage plan. It is one or the other.
Side-by-Side Comparison
| Medicare Advantage | Medigap + Part D | |
|---|---|---|
| Monthly premium | Often low (plus Part B) | Higher (plus Part B and Part D) |
| Costs when you use care | Copays and coinsurance, up to a yearly limit | Low and predictable, depending on the plan letter |
| Doctors | Usually a network | Any provider that accepts Medicare |
| Prior authorization | Common | Rarely, with Original Medicare |
| Drug coverage | Usually included | Separate Part D plan |
| Extras (dental, vision) | Some plans | Not included |
Questions to Ask Yourself
- Are my doctors and hospitals in the plan’s network?
- Are my prescriptions on the plan’s drug list, and at what cost?
- Do I travel or spend part of the year outside Texas?
- What is the most I could pay in a bad health year, not just the monthly premium?
- Could I pass health questions if I want to switch to Medigap later?
There is no single right answer. A plan that fits a healthy person who stays close to home may be a poor fit for someone who sees specialists often or travels.
If You Choose Medicare Advantage: Watch the Hospital Copays
Many Advantage plans charge a daily copay for hospital stays. Some people add a hospital indemnity policy, which pays cash directly to you if you are hospitalized. See our hospital indemnity guide.
For official information on all of your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Compare Medicare plans
To compare Medicare Advantage and Part D plans, call our Medicare partner line at (833) 631-7640. Calls to this number are answered by licensed Medicare agents at our enrollment partner, not by Brilliant Insurance.
About Brilliant Insurance
Brilliant Insurance is an independent agency in Plano, Texas. David Gustafson (Texas License #2116912, NPN 18037219) helps with life insurance and supplemental plans such as hospital indemnity. For those, book a free 30-minute call or call (972) 750-3031.
This article is general information, not advice for your situation. Medicare costs shown are 2026 figures from CMS and change every year. Plans, benefits and availability vary by plan and location.
