Medicare Advantage vs. Medicare Supplement: which is right for Texans?

This is the single most important decision in Medicare, and most people don't think about it carefully enough.

On one side: Medicare Advantage, where a private insurance company replaces Original Medicare and bundles everything into one plan. Often $0 monthly premium. Usually includes drug coverage, sometimes dental and vision. The catch: you stay in the plan's network.

On the other side: Original Medicare + Medicare Supplement (Medigap), where you keep Original Medicare and add a separate Supplement policy to cover the gaps. Higher monthly premium. Predictable out-of-pocket costs. Any doctor in the country that accepts Medicare. No network restrictions.

Both are legitimate. Both work for the right people. There's no universal right answer. But for any given Texan, one is usually a much better fit than the other.

The core trade-off in one sentence

Medicare Advantage trades flexibility for low premiums. Medicare Supplement trades higher premiums for flexibility and predictability.

Everything else flows from this. If you want low monthly cost and you're willing to accept network restrictions and variable copays — Advantage. If you want certainty and freedom and you're willing to pay more per month — Supplement.

Side-by-side: the real differences

Factor	Medicare Advantage	Medicare Supplement
Monthly premium	Often $0 (plus Part B)	$100–$300+ (plus Part B + Part D)
Doctor choice	In-network only (HMO) or higher cost out-of-network (PPO)	Any doctor in U.S. that accepts Medicare
Referrals	Often required (HMO)	Never required
Out-of-pocket costs	Variable (copays, coinsurance)	Very predictable
Annual cap	Yes (federal limit ~$9,350 in 2026)	No cap, but very low costs after premium
Prescription drugs	Usually included in plan	Buy separate Part D plan
Dental, vision, hearing	Often included	Not included (buy separate plans)
Travel coverage	Limited outside service area	Excellent — works anywhere in U.S.
Foreign travel emergency	Limited	80% covered (Plan G/N)
Underwriting after open enrollment	No (guaranteed issue)	Yes in Texas (carriers can decline)

When Medicare Advantage is usually the right answer

You want low monthly costs

If you're on a fixed income and your Social Security barely covers your basics, a $0 premium plan is real money. Yes, you'll pay copays when you use care — but if you don't see a lot of doctors, you'll spend less overall than someone with Supplement.

Your doctors are local and you don't travel much

If your primary care doctor, your specialists, and your hospital are all in San Antonio (or wherever you live) and you don't expect to move or travel a lot, network restrictions don't matter as much. The plan's San Antonio network likely includes who you need.

You want everything bundled

Drug coverage, dental, vision, hearing, gym membership, transportation to medical appointments — many Advantage plans include all of this. One plan, one card, one renewal. Simple.

You're relatively healthy

If you only see doctors a few times a year for routine care, Advantage's lower premium pays off. The copays you'd hit are limited and your annual out-of-pocket is capped at the federal limit.

When Medicare Supplement is usually the right answer

You want very predictable costs

With Plan G, after you meet the Part B deductible ($257 in 2026), almost everything else is covered. You'll pay a higher monthly premium, but you'll know exactly what your healthcare costs every month for the next 12 months. Zero surprises.

You travel between states or have family far away

Medigap doesn't have networks — any doctor in any state that accepts Medicare accepts your Medigap policy. This is the right answer for Texans who snowbird in Arizona, visit grandkids in Colorado, or split time between Hill Country and Florida.

You have specialists you can't lose

If you've built a relationship with an oncologist at MD Anderson, a cardiologist at Methodist Stone Oak, or any specialist whose network status could change year to year — Medigap protects you. No network changes, no surprises.

You use a lot of healthcare

If you're in worse-than-average health, the higher Medigap premium pays for itself many times over. Advantage's "low premium" is offset by copays that accumulate when you use care frequently. Medigap caps your effective spending much lower.

You want to choose your own Part D plan

With Advantage, you typically use the drug formulary the plan includes — take it or leave it. With Medigap, you separately choose a Part D plan that best fits your specific medications. For people on multiple brand-name drugs, this flexibility can save thousands.

The Texas-specific underwriting issue

This is the most important rule most agents don't tell you up front:

This means: if you're at all unsure whether you might want Medigap eventually, the safest play is to start with Medigap during your open enrollment window. You can always switch from Medigap to Advantage later (Advantage has guaranteed issue annually). But going the other direction may not be possible.

A simple decision framework

Ask yourself these five questions:

1. Do I have a fixed budget for premiums? If yes, low-premium Advantage may be necessary. If you have flexibility, Medigap is worth considering.
2. Will I travel between states or move in the next 10–20 years? If yes, lean Medigap.
3. Do I have specialists I can't risk losing? If yes, lean Medigap.
4. Am I in good health, expecting limited medical use? If yes, Advantage usually wins on total cost.
5. Do I want one plan that covers everything (drugs, dental, vision)? If yes, lean Advantage.

Three or more "yes" answers in one direction usually points clearly toward one path.

What does this cost in San Antonio?

Medicare Advantage: Many plans are $0 monthly premium (you still pay your Part B premium, which is $185/month standard in 2026). Copays and coinsurance vary. Annual out-of-pocket maximums are capped at the federal limit.

Medicare Supplement: Plan G premiums for a 65-year-old in San Antonio typically run $110–$180/month depending on carrier. Add a Part D plan (typically $5–$50/month) and you're at $115–$230/month total. After the Part B deductible, most care is covered.

The bottom line

If you have a fixed budget and stay local: Medicare Advantage.

If you want predictability, flexibility, and travel coverage: Medicare Supplement.

The wrong answer for almost everyone is "the one with the lowest premium" — that's how people end up in plans that don't cover their doctor or their prescriptions. Compare with someone who's looking at your specific situation.