The Real Cost Comparison
Medicare Advantage plans often advertise $0 premiums, which sounds great — until you look at what happens when you actually use healthcare. These plans come with copays, coinsurance, and out-of-pocket maximums that can reach $7,550 or more per year. Medigap plans charge a monthly premium (typically $150–$350 in DFW), but in exchange, your out-of-pocket costs when you see a doctor are minimal or zero.
For a healthy 65-year-old who rarely sees a doctor, Advantage may cost less in the short term. But if you develop a chronic condition, need surgery, or require specialist care at Baylor, UT Southwestern, or Texas Health — Medigap's predictable costs often win out.
DFW Network Access Matters
This is where geography makes a real difference. Medicare Advantage plans use provider networks (HMO or PPO). In DFW, that means your access to specific hospitals and specialists depends entirely on which plan you choose. Some Advantage plans don't include UT Southwestern. Others restrict access to certain Baylor locations.
Medigap plans, on the other hand, work with any provider that accepts Original Medicare — which is virtually every hospital and doctor in DFW. No network restrictions, no referral requirements, no prior authorizations.
The Enrollment Window You Can't Undo
Here's the part most people don't hear until it's too late: your Medigap Open Enrollment Period is a one-time, six-month window that starts when you turn 65 and enroll in Medicare Part B. During this window, insurance companies must accept you regardless of health conditions — no medical underwriting.
After this window closes, you can still apply for Medigap — but insurers can deny you based on health conditions, charge you more, or exclude pre-existing conditions. This means a decision you make at 65 can permanently close doors at 70.
Our Recommendation
There's no universal right answer — it depends on your health, your budget, your doctors, and how much financial predictability you need. What we always tell clients: understand both options fully before your enrollment window closes, because you can always switch from Medigap to Advantage later, but you often can't go the other direction.
