Medicare Supplements vs. PPO Plans—What Should You Choose?

If you’re currently on a Medigap plan, you might be feeling the pinch of high premiums, or your insurer might be leaving your area entirely next year. As stressful as that can be, you don’t need to worry. You have options and time to make the right decision for your health—especially now, during the Annual Enrollment Period. 

Understanding Your Current Coverage: Original Medicare and Medigap

A Medicare Supplement Insurance (Medigap) is an additional type of plan you can buy from a private insurer that works alongside Original Medicare. It helps cover the 20% copayments and other out-of-pocket expenses that Original Medicare doesn’t pay. Use of a Medigap is seemingly straightforward: You can see any doctor nationwide who accepts Medicare, and your Medigap helps pick up the tab.

Convenience, however, does cost you. While on Original Medicare with a Medigap plan, you’re paying premiums for Medicare Part B, Part D (prescription drug coverage) and your Medigap policy. Those premiums add up each month, and once you’re past your initial six-month Medigap Open Enrollment window, which only happens once when you first get Part B, getting back into Medigap becomes difficult and expensive if you ever leave it. Miss that window, or leave your plan? You’ll likely face medical underwriting and higher rates if you try to return.

Rigidity is one of Medigap’s biggest drawbacks. The plans are standardized, which means limited variety, and your enrollment options are limited, too. If your needs change, you could find yourself in a costly bind.

The Alternative: Medicare Advantage PPO Plans

Medicare Advantage plans take a different approach from Medigap. Instead of supplementing Original Medicare, they replace it entirely, bundling Parts A, B and usually D into one plan from a private insurer. This is referred to as Medicare Part C. Within Medicare Advantage, there are different plan options, such as PPO (Preferred Provider Organization) plans, which are a good alternative in coverage and cost to Original Medicare with a Medigap supplement.

Lower Out-of-Pocket Costs

Most Medicare Advantage PPO (MA PPO) plans have significantly lower monthly costs than Medigap—many with a $0 premium—though you still have to pay for Medicare Part B. The savings don’t end there. Even with copays when you use services, your total annual out-of-pocket costs are often lower than what you’re paying now for the separate premiums. Plus, Medicare Advantage plans have an annual out-of-pocket maximum, giving you a cap on your costs that Medigap doesn’t provide.

More Benefits Included

MA PPO plans typically include vision, dental and hearing coverage—these benefits are not included with Original Medicare and must be paid for separately with Medigap. Many plans also offer preventive care benefits you won’t find in Original Medicare, helping you stay healthier while spending less.

Flexibility You Can Work With

It may seem surprising, but MA PPO plans offer more flexibility than most would expect. Yes, PPO plans have provider networks, and your costs are lower when you stay in-network, but you don’t need referrals to see specialists. You can also see out-of-network providers (as long as they accept Medicare), but you’ll pay a bit more. Unlike Medigap’s one-time enrollment, you can reevaluate your Medicare Advantage plan every single year during Annual Enrollment from October 15 to December 7. If your needs change, you can switch plans for next year without fear of being locked in if you decide to go back in a year. That’s flexibility Medigap simply doesn’t offer.

There are more limitations to care nationwide than Original Medicare, but if your care is primarily local, an MA PPO may work well for you. Medicare Advantage also standardizes some costs. PPOs can’t charge more than Original Medicare for services like chemotherapy, dialysis and skilled nursing facility care, giving you predictable pricing where it matters most.

Important Considerations Before Leaving Medigap

If you’re thinking about voluntarily switching from Medigap to Medicare Advantage, there are a few things you should carefully consider:

Once you leave your Medigap plan, getting back into Medigap later can be extremely difficult. In most states, you’ll face medical underwriting—meaning insurance companies can ask health questions, deny you coverage, or charge significantly higher premiums based on your health conditions. The guaranteed issue protections you had during your initial enrollment don’t come back.

You’ll also be moving from nationwide coverage to a regional network. While PPO plans offer out-of-network options, your costs will be higher. Additionally, if you frequently travel or spend extended time in different states, this could impact your access to affordable care. Be sure the MA PPO plan you choose fits your lifestyle. The BSW SeniorCare Advantage PPO plan, for example, includes worldwide coverage for urgently needed services, including emergency care, urgently needed care, and emergency/urgently needed care transportation services.

Your Timeline

The important thing to know is that you have options. If your Medigap insurer is leaving your area or discontinuing your plan, you have a 63-day window from the date of your notification to make a change. If you’re voluntarily leaving Medigap because of costs or to get better benefits, the Annual Enrollment Period—happening right now through December 7—is your only opportunity this year to switch to a Medicare Advantage plan. This is your window to make a change that could save you money and give you more comprehensive coverage.

What This Means for You

If you’re looking to switch to a Medicare Advantage plan from Original Medicare with Medigap, this is your chance to consider a PPO plan. Both Medigap and Medicare Advantage PPO plans help you manage healthcare costs, just in different ways. The right choice depends on your specific situation: where you live, how you use healthcare and what matters most to you.

Speaking to a licensed broker can help you compare specific plans available in your area and find the one that fits your needs and budget. Contact a Baylor Scott & White Health Plan licensed insurance agent for a consultation on your options and guidance on finding a plan that’s best for you or your loved ones at 1.833.975.0841 (TTY: 711).