Medigap vs Medicare Advantage for Cancer Patients: Which Is Better?

A cancer diagnosis changes everything, including how you think about health insurance. If you're on Medicare and facing cancer treatment, or if you're choosing Medicare coverage and have a history of cancer, the decision between Medigap and Medicare Advantage becomes critically important.

The wrong choice could mean thousands of dollars in unexpected costs, limited access to specialists, or complications with out-of-network treatment. This guide provides an honest, unbiased comparison to help you make the best decision for your situation.

Why This Decision Matters for Cancer Patients

Cancer treatment isn't like treating a broken bone or managing diabetes. It often involves:

• Multiple specialists - oncologists, surgeons, radiologists, and more
• Treatment at specialized cancer centers - sometimes hundreds of miles away
• Clinical trials - which may only be available at specific facilities
• Frequent and ongoing care - chemotherapy, radiation, follow-ups
• High costs - cancer treatment can cost $100,000+ per year

Your Medicare coverage choice directly affects your access to care, your out-of-pocket costs, and your flexibility to seek treatment wherever it's best for your specific cancer.

Medigap vs Medicare Advantage: Head-to-Head Comparison

Why Medigap Is Often Better for Cancer Patients

1. Unrestricted Access to Specialists and Cancer Centers

With Medigap, you can see any oncologist, surgeon, or specialist who accepts Medicare. This includes:

• NCI-designated cancer centers - The 72 National Cancer Institute centers, including MD Anderson, Memorial Sloan Kettering, and Mayo Clinic
• Academic medical centers - Often leaders in cutting-edge treatment
• Specialists anywhere in the country - No network restrictions

With Medicare Advantage, you're typically limited to in-network providers. While some MA plans have broad networks, many specialized cancer centers are out-of-network, meaning higher costs or no coverage at all.

2. No Prior Authorization Delays

Medicare Advantage plans frequently require prior authorization for:

• PET scans and advanced imaging
• Chemotherapy and targeted therapies
• Radiation treatment
• Specialist consultations
• Certain surgeries

These authorization requirements can delay treatment by days or weeks. With cancer, time matters. Original Medicare with Medigap has no prior authorization requirements for Medicare-covered services.

3. Predictable, Lower Out-of-Pocket Costs

Cancer treatment is expensive. Here's how costs compare:

Medigap Plan G:

• You pay the Part B deductible ($257 in 2025)
• Medigap pays the remaining 20% coinsurance
• Your total out-of-pocket: ~$257/year for Part B services

Medicare Advantage:

• You pay copays and coinsurance for every service
• 20% coinsurance on chemotherapy could = thousands per treatment
• Maximum out-of-pocket: up to $8,850/year (in-network only)

If your cancer treatment costs $200,000 in a year, your Medigap out-of-pocket remains around $257. With Medicare Advantage, you'd pay up to $8,850 (and potentially more if any care is out-of-network).

4. Freedom to Seek Treatment Anywhere

The best treatment for your specific cancer might be at a facility across the country. With Medigap:

• Treatment at any U.S. facility that accepts Medicare is covered
• No need to worry about network restrictions
• Coverage works the same whether you're at home or traveling

Medicare Advantage plans typically limit coverage to your service area, with only emergency care covered elsewhere.

5. Easier Access to Clinical Trials

Clinical trials can offer access to cutting-edge treatments not yet widely available. With Original Medicare + Medigap:

• Medicare covers routine costs of clinical trial participation
• No prior authorization needed
• You can participate in trials anywhere in the country

Medicare Advantage plans may restrict clinical trial participation or require authorization, limiting your options.

When Medicare Advantage Might Work

Medicare Advantage isn't always the wrong choice. It may work for cancer patients if:

• Your oncologist and cancer center are in-network - and you're comfortable staying there
• The plan has a $0 premium - and you can't afford Medigap premiums
• You need extra benefits - like dental, vision, or transportation to treatments
• Your cancer is stable - and you're in maintenance/monitoring phase

However, these advantages come with real trade-offs in flexibility and cost protection.

What If You're Already Diagnosed with Cancer?

If you currently have Medicare Advantage and receive a cancer diagnosis, your options for switching to Medigap may be limited.

The Challenge: Medical Underwriting

Outside of your Initial Enrollment Period (when you first turn 65) and certain Special Enrollment Periods, Medigap insurance companies can:

• Ask health questions on the application
• Deny coverage based on pre-existing conditions
• Charge higher premiums based on health status

An active cancer diagnosis will likely result in denial of Medigap coverage or significantly higher premiums in most states.

Options If You're Stuck in Medicare Advantage

If you can't switch to Medigap due to your health:

1. Review your plan's network carefully - Identify in-network oncologists and cancer centers
2. Understand prior authorization requirements - Know what needs approval before scheduling
3. Appeal denials promptly - You have the right to appeal any coverage denial
4. Consider switching MA plans - During Annual Enrollment, you can switch to an MA plan with better cancer coverage or a broader network
5. Ask about exceptions - Some plans allow out-of-network care in special circumstances

How to Choose: Questions to Ask

Before making your decision, answer these questions:

1. Do I have a cancer history or high risk? If yes, Medigap's flexibility is more valuable.
2. Can I afford Medigap premiums? Factor in potential MA out-of-pocket costs too.
3. Are the best cancer centers in my area in-network? Check before assuming MA will work.
4. Am I willing to be locked into a network? Consider what happens if you need care elsewhere.
5. Do I travel or split time between locations? Medigap works everywhere; MA may not.

Our Recommendation

If you're choosing Medicare coverage and have any cancer concerns (history, family history, or high risk), we strongly recommend Original Medicare with a Medigap plan and a standalone Part D drug plan.

The higher monthly premium for Medigap is insurance against:

• Network restrictions that limit your treatment options
• Prior authorization delays when time is critical
• Potentially $8,000+ in annual out-of-pocket costs
• Being unable to access the best specialists for your cancer type

If you already have Medicare Advantage, evaluate whether you have guaranteed issue rights to switch. If not, maximize your current coverage by understanding your plan's oncology network and appeal rights.