Major decision -- and one-time opportunity -- Advantage vs. Medigap. (Whether or not receiving benefits subsidized by HPInc or HPE.)

Menu of Benefits Enrollment pages: Enrollment Menu 

Based on reports from HP Alumni Association members who have completed enrollment. Join forums: https://www.hpalumni.org  Not officially endorsed or supported. Question? Email us: info@hpalumni.org  (Updated Nov 24, 2025)

Situation:

If you are converting from an HPInc or HPE private group Medicare plan to an open-market individual plan, you have a one-time opportunity to change your Medicare strategy.

If you are new to Medicare, you need to select your Medicare strategy -- choosing between Advantage and Medigap coverage.

Depending on your financial and health situation, your preference for your current doctors and medical system, and your personal tolerance for risk, you may want to take advantage of this one-time opportunity to move from your current Advantage group coverage to a Medigap plan -- without the normally-required "medical underwriting." evaluation of your current health.

Much information about Medicare on websites or in the media is oversimplified, out-of-date, or biased for business reasons.

Advantage plans are more profitable for insurers than Medigap plans -- thus the heavy advertising for Advantage and none for Medigap.

The fact that Medigap plans are available is often hidden. Sutter Health's "Your Health Insurance Information Guide" only covers Advantage. The loss-of-coverage letter from UnitedHealthcare -- notifying you that you will no longer have an HPInc or HPE group plan -- invites you to buy a UHC Advantage plan, but doesn't mention UHC's Medigap plans.

Note: While group plans are often called "Advantage" plans, they usually have different features from similarly-named individual Advantage plans from the same insurer.

Official information on Medicare.

The official Medicare site http://www.medicare.gov is very thorough and well done. (Not medicare <dot> com ! )

Use the very clear official "Medicare & You" book. You were sent the paperback via U.S. Mail. You can download it.
- Pages 13-20 explain what you need to do -- and when.
- Pages 9-12 explain and compare Original Medicare, Original + Medigap, and Medicare Advantage plans.

Download the file at https://www.medicare.gov/publications/10050-medicare-and-you.pdf  Click on terms, phrases, and issues to go to sections in the book -- or to other articles on the site.

More detailed articles on the official Medicare site:
- "Understanding Medicare Advantage Plans" https://www.medicare.gov/publications/12026-understanding-medicare-advantage-plans.pdf
- "Choosing a Medigap Policy" https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf
- "Your Guide to Medicare Prescription Drug Coverage" https://www.medicare.gov/publications/11109-your-guide-to-medicare-prescription-drug-coverage.pdf

Why is Advantage so inexpensive compared to Medigap?

- Higher government funding.
- Limiting available doctors, hospitals, and other providers.
- Limiting services or provider selection through prior authorization.

Higher government funding.

To compensate for local cost variations, government payments -- and policy prices -- vary by county, as determined by zip code.

With both Advantage and Medigap, you pay the same monthly Part B premium -- usually deducted from your Social Security payments.

Under Original Medicare, providers are paid by the government for each specific service rendered to you. Every visit, every phone call, every bandage is coded and charged under Medicare procedures and audits.

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurer to help pay your share of Original Medicare out-of-pocket costs -- such as copayments, coinsurance, and deductibles.

Under an Advantage plan, you sign over your Medicare rights to a health insurer. The government pays the insurer a monthly amount, which depends heavily on a rating of your health -- determined by the insurer, not by your doctors. (Insurers analyze medical records and employ nurses to make phone calls and home visits.)

In short, the Advantage insurer makes more profit if you receive less service -- and is therefore in contention with providers over the charges.

Payments to Medicare Advantage plans are estimated to be 1.2 times what Original Medicare would have spent on the same beneficiary.

Advantage plans are also preferred by most insurance sales agencies. Once an application is approved by an insurer, the sales agency is paid an initial commission -- and continuing commissions every year for servicing your account. Advantage: $700-$860 for initial sale; $350-$430 for each year thereafter. Medigap: typically $260-$440 (22%) initial year and each year for five more years. Part D: $114, then $57/year.

Limiting available doctors, hospitals, and other providers.

To keep your doctors, your new plan may have to be a Medigap plan instead of an Advantage plan.

Do not rely on any online database -- whether from a health system, or from an insurer, or from an insurance sales agency (including Alight) or even the official Medicare Advantage plan directory.

That is fragile, constantly-changing, second- or third-hand information -- and may not be valid for the coming year.

Some doctors have multiple affiliations or locations. Especially common with specialists.

Original Medicare (Medigap): You may see any provider that accepts Medicare and, if you are new to the provider, accepts new patients. In 2024, 98% of physicians participated in Medicare. (Because any provider that accepts Medicare must accept any Medigap plan, specific Medigap plans are not listed on a provider's website.)

Health systems vary in whether they accept new Original Medicare patients who were not existing patients. Some only grudgingly accept Original Medicare -- and therefore Medigap -- at all.

For example, in the SF Bay Area, Sutter/PAMF has a page for each doctor, listing the Advantage plans they accept. It is very hard to find anything about Original Medicare on the Sutter website. El Camino Health, by contrast, simply lists "Medicare" in the alphabetical list of specific Advantage plans on each doctor's page.

Check directly with the doctors' offices. Ask for the "billing specialist" or the "billing office." Specify whether you are an existing patient, and ask if they will be accepting Medicare next year.

Advantage plans limit their costs by using only a "network" of providers. Research showed that the share of physicians available to Medicare Advantage enrollees ranges from an average of 18% in San Diego to an average of 58% in Tucson.

So far in 2025,  "...38 hospital systems serving all or parts of 23 states have cut ties with at least 11 Advantage plans after failing to agree on payment and other issues... After March, Medicare Advantage beneficiaries are generally locked into their plans for the year until the annual open enrollment period."

A provider can leave an Advantage plan's network at any time. If that happens, you must choose a new provider from that network. The official Medicare site advises: "Check with your provider when you schedule an appointment to confirm they’re still in your plan’s network."

Heads up! If you are considering an Advantage plan, check directly with the doctors' offices to see if your current doctors and other providers will be accepting that specific plan next year. 

Check directly with the doctors' offices to determine if your current doctors and other providers will be accepting the Advantage plan that you are considering. Ask for the "billing specialist" or the "billing office." Specify whether you are an existing patient, and ask if they will be accepting that specific Advantage plan next year.

For example, as of Nov 24, Sutter/PAMF lists many Advantage plans, but none from UnitedHealthcare -- "Currently in Contract Negotiations."

One member: "I checked to see if this physician was in network and she was BUT as it turned out, NOT in the location where I went for treatment. I discovered this when I only received a portion of the amount of the reimbursement I expected."

Limiting services or provider selection through prior authorization.

Original Medicare: Prior authorization to see a specialist is rarely required and only applies to a limited set of services.

Advantage: Prior authorization is required for many treatments -- even common treatments. This consumes doctor and staff time wrestling with automated processes, may involve tedious appeal cycles, and can seriously delay treatment. (One reason a doctor may elect to not accept Advantage plans.) Insurers are telling their stockholders that they will be using AI to automate this function -- making it even easier to flood doctors and staff with time-consuming messages.

Drug coverage -- Advantage or Part D.

You can choose to enroll in either a Medicare Advantage drug plan (MA-PD) that includes drug coverage and all other Medicare-covered benefits -- or in a stand-alone prescription drug plan (PDP) to supplement traditional Medicare..

Why are some Part D plans free? The government is paying an average of $1,710/year for your Part D coverage.

Heads up! For drug coverage, use the insurer's "formulary" database. Other sources, such as sales agency databases are not reliable -- fragile, constantly-changing, second- or third-hand information.

Original Medicare: You choose among stand-alone prescription drug plans (Part D) offered in your county. Often introductory prices to capture market share. Member reports: $0.40/month Wellcare Part D went up to $17.40/month. A Humana Part D went up dramatically -- next year, they had a new very-low-cost Part D plan with a different name and plan number.

Advantage: Some Advantage plans do not include drug coverage. Some may charge a drug deductible.

(This page is based on reports from HPAlumni members, research -- plus articles and reports from KFF, the nonprofit health policy research and news organization.)

Next step: Menu of key Enrollment issues: https://www.hpalumni.org/enroll-menu

Helping each other with life after Hewlett-Packard, HP Inc, and HPE. Join independent HP/HPE forums