Medicare Advantage vs. Medigap in Florida: How They Differ and Why the First Choice Matters

With Original Medicare, Medicare pays doctors and hospitals directly, and "you can use any doctor or hospital that takes Medicare, anywhere in the U.S." (Medicare.gov). You pay deductibles and usually 20% coinsurance for Part B services, with no annual cap. A Medigap policy is private insurance that fills some or all of those gaps. Drug coverage comes from a separate Part D plan.

Medicare Advantage (Part C) is a private plan approved by Medicare that takes the place of Parts A and B, often with drug coverage built in. Plans use networks of doctors and hospitals and may require referrals or prior approval. Every plan has a yearly out-of-pocket limit, and once you reach it, the plan pays 100% of covered services for the rest of the year (Medicare.gov, costs).

You can't combine the two. It's illegal to sell you a Medigap policy if you're in a Medicare Advantage plan, unless you're switching back to Original Medicare, and Medigap can't pay Medicare Advantage copays or premiums (Medicare.gov).

On both paths, you generally keep paying the Part B premium, $202.90 a month in 2026 (CMS). After that, the cost patterns differ:

Medigap: a monthly premium for the policy and another for Part D, then low or predictable costs when you get care. Medicare Advantage: often a low plan premium, then copays and coinsurance as you use care, up to the plan's annual limit.

Networks matter more in Florida than people expect. Many residents split the year between states or want access to a particular cancer center or specialist. A Medicare Advantage network is usually local, and out-of-network care may cost more or not be covered. Original Medicare with Medigap travels with you anywhere in the U.S. Before choosing, check whether your doctors, your hospital and any nursing home you'd use are in a plan's network.

This is the part many families learn too late. Florida law guarantees Medigap enrollment, with no health questions and no higher price for health, in two windows (Fla. Stat. 627.6741(1)(a)):

the 6 months starting with the first month you're 65 or older and enrolled in Part B. Floridians under 65 who are on Medicare because of disability or end-stage renal disease get the same 6-month window; the 2 months after group health coverage ends, if you're enrolled in Part B.

Federal law adds guaranteed-issue rights in specific situations (42 U.S.C. 1395ss(s)(3)), including:

you joined Medicare Advantage when first eligible at 65 and leave within 12 months; you dropped a Medigap policy to join Medicare Advantage for the first time and leave within 12 months. You can get the old policy back if the same insurer still sells it; your plan leaves your area, or you move out of its service area; your Medigap insurer goes bankrupt or misled you.

You generally apply from 60 days before to 63 days after the old coverage ends (Medicare.gov).

Outside these windows, you can leave Medicare Advantage for Original Medicare each year from October 15 to December 7, or from January 1 to March 31 (42 CFR 422.62). But a Medigap insurer can deny you or charge more based on your health (Medicare.gov). Someone who develops a serious illness while in Medicare Advantage may find they can't buy Medigap at all.

Original Medicare covers skilled nursing facility care after a qualifying inpatient hospital stay of 3 days, with coinsurance of $217 a day for days 21 through 100 in 2026 (CMS). Many standard Medigap plans pay that coinsurance (Medicare.gov, compare Medigap plans).

Medicare Advantage plans set their own skilled nursing copays and usually require prior authorization. Federal rules let them cover skilled nursing care without the 3-day stay (42 CFR 422.101(c)(2)). Read the plan's Evidence of Coverage for the details.

Neither path pays for long-term custodial care in a nursing home. When the skilled stay ends, families turn to private pay or Medicaid. Our guides on Medicare non-coverage notices and nursing home admission explain what to do then.

If you have both Medicare and Medicaid, the choice changes. A Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan for people who also have Medicaid, and it can help coordinate the two programs' benefits (Medicare.gov, special needs plans). Insurers generally can't sell you a Medigap policy if you have Medicaid, and with full Medicaid one is usually unnecessary (Medicare.gov).

Planning points:

After Medicaid approval for nursing home care, review whether a Medigap policy is still worth its premium. If Medicaid pays your Part B premium through a Medicare Savings Program, see our Medicare Savings Programs guide. A D-SNP has to be dropped before joining PACE. See our PACE guide.