Understanding the Two Main Paths: What Are These Plans?
First, it's important to know that these are not the same thing. They represent two different ways to structure your Medicare coverage. Think of it as a fork in the road after you've enrolled in Original Medicare Parts A and B.
Medicare Advantage (also called Part C) is an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies approved by Medicare. They bundle your Part A (hospital) and Part B (medical) coverage into a single plan. Most also include Part D prescription drug coverage (these are called MAPD plans). You are still in the Medicare program, but the private company manages your care. These plans typically have specific networks of doctors and hospitals (like an HMO or PPO) and often include extra benefits not covered by Original Medicare, such as routine dental, vision, and hearing care.
Medigap (also called a Medicare Supplement) is insurance that you buy in addition to your Original Medicare. It does exactly what its name implies: it helps fill the gaps in what Original Medicare doesn't cover, like your deductibles, copayments, and coinsurance. You keep Original Medicare as your primary coverage, and the Medigap plan pays its share of the costs after Medicare pays its portion. Medigap plans are standardized by letter (e.g., Plan G, Plan N), meaning a Plan G from one company has the exact same core benefits as a Plan G from another. These plans do not include drug coverage, so you must purchase a separate Part D prescription drug plan.
Costs: Monthly Premiums vs. Out-of-Pocket Expenses
The cost structure is the most significant difference between these two options. With either choice, you must continue to pay your monthly Medicare Part B premium to the government. For 2026, this amount will likely be around $185 per month or higher, depending on your income.
Medicare Advantage plans are known for their low, and often zero-dollar, monthly premiums. This can be very attractive. In exchange for that low premium, you agree to pay for services as you use them in the form of copays and coinsurance. For example, you might pay $10 for a primary care visit, $40 for a specialist visit, and a few hundred dollars per day for a hospital stay, up to a certain limit. Each plan has an annual maximum out-of-pocket (MOOP) limit. For 2026, this limit could be as high as $9,400 for in-network care, though many plans in the Uniontown area will have lower limits. Your costs are less predictable and depend entirely on your health needs during the year.
Medigap plans work the opposite way. You pay a higher monthly premium to the insurance company, typically ranging from about $120 to over $250 per month, depending on the plan, your age, and other factors. In return, your out-of-pocket costs for Medicare-approved services are minimal or even zero. With a Medigap Plan G, for instance, once you pay the annual Part B deductible ($254 in 2025, with the 2026 figure to be announced), you generally have no other copays or coinsurance for Part A and B services. This model offers highly predictable healthcare budgeting, as your main expense is the fixed monthly premium.
Doctor Networks, Referrals, and Flexibility
Your freedom to choose doctors and hospitals is another major point of comparison. This is especially relevant for residents of communities like Uniontown, who may have doctors in both the Canton and Akron areas.
Medigap plans offer the most freedom. Because you are using Original Medicare as your primary coverage, you can see any doctor or visit any hospital in the entire United States that accepts Medicare. There are no networks. You do not need a referral from a primary care physician to see a specialist. If your family doctor in Green recommends a cardiologist affiliated with Summa Health and a urologist at Mercy Medical Center in Canton, you can see both without worrying if they are in or out of a network. This freedom is also valuable for snowbirds who spend part of the year out of Ohio.
Medicare Advantage plans, on the other hand, almost always have a local or regional provider network. These are typically structured as HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations). With an HMO, you generally must use doctors, hospitals, and specialists within the plan's network, except in an emergency. You also may need a referral to see a specialist. With a PPO, you have more flexibility to see out-of-network providers, but your costs will be significantly higher than if you stay in-network. Before enrolling, it is essential to check if your current doctors, preferred hospitals like Mercy Medical Center, and any specialists you see are part of the plan's network.
Coverage for Prescriptions and Extra Benefits
The way prescription drugs and ancillary benefits are handled is a clear dividing line between the two paths. Original Medicare and Medigap plans do not cover most outpatient prescription drugs. They also do not cover routine dental care, glasses or contacts, or hearing aids.
If you choose the Medigap route, you will need to purchase a separate, standalone Medicare Part D plan for your prescription drug coverage. These plans carry their own monthly premium and have their own formulary (list of covered drugs), deductibles, and copays. This 'unbundling' allows you to pick the specific drug plan that best covers your particular medications, but it does mean managing an extra policy and premium. The total monthly cost is your Part B premium, your Medigap premium, and your Part D premium.
Most Medicare Advantage plans take an all-in-one approach. The majority of plans available in Stark County are MAPD plans, meaning prescription drug coverage is built right in. This simplifies things by combining medical and drug coverage into one plan with one ID card. Furthermore, a key selling point for MA plans is the inclusion of extra benefits. Most offer some coverage for routine dental exams, cleanings, vision exams, and an allowance for eyewear. Many also include gym memberships (like SilverSneakers), transportation to medical appointments, and over-the-counter allowances, none of which are offered by Medigap.
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Who is a Medigap Plan Best For? A Uniontown Example
A Medigap plan is often a good fit for someone who prioritizes budget predictability and freedom of choice over a low monthly premium. This person would rather pay a higher, fixed monthly cost and know that their medical bills will be covered, no matter how much care they need during the year.
Consider a 68-year-old woman in Uniontown who was recently diagnosed with a chronic condition that requires regular visits to multiple specialists. Her primary doctor is in North Canton, but her rheumatologist is at a clinic in Akron. She also travels to visit her children in North Carolina for two months every year. For her, a Medigap plan (like a Plan G) combined with a Part D plan is an ideal solution. She can continue to see all her current doctors without checking a network directory. When she's in North Carolina, she knows she can see any doctor who accepts Medicare if an issue arises. She pays her monthly premiums for Part B, Medigap, and Part D, but when she visits a doctor or has a procedure, her out-of-pocket costs are negligible after meeting the small annual Part B deductible. The peace of knowing her healthcare costs are almost entirely fixed is worth the higher monthly payment.
Who is a Medicare Advantage Plan Best For? An Ohio Scenario
A Medicare Advantage plan is often suitable for individuals who are relatively healthy, are comfortable using a provider network, and want the lowest possible monthly premium. These members appreciate the convenience of an all-in-one plan and the value of the included dental, vision, and hearing benefits.
Let's imagine a husband and wife, both 65, who just retired from their jobs in Hartville and live in Uniontown. They are in good health and mostly see their primary care physician for annual check-ups. They've checked and confirmed their doctor and the local hospital, Mercy Medical Center, are in the network of a zero-premium PPO plan available in their 44685 ZIP code. The idea of not paying an additional premium beyond their Part B payment is very appealing. They like that the plan includes dental cleanings, an allowance for new glasses, and a gym membership. They understand that if they need to see a specialist or have a hospital stay, they will have copays. But they are comfortable with this pay-as-you-go model, knowing their total costs are capped by the plan's annual maximum out-of-pocket limit. For them, the immediate savings and extra perks outweigh the network limitations.
Important Rules for Switching and Getting Help
Choosing a path isn't always permanent, but there are important rules to know. Your easiest time to get a Medigap plan is during your 6-month Medigap Open Enrollment Period, which starts the first month you have Part B coverage and are 65 or older. During this window, companies cannot deny you a policy or charge you more due to health conditions. Outside of this period, you generally have to answer health questions (undergo medical underwriting) to switch Medigap plans or buy one for the first time, and you can be denied.
Medicare Advantage plans have more defined annual windows for changes. The Annual Enrollment Period runs from October 15 to December 7 each year, where anyone can join, drop, or switch MA plans. There is also a Medicare Advantage Open Enrollment Period from January 1 to March 31 where you can switch from one MA plan to another or go back to Original Medicare. There is a special 'trial right' as well: if you join an MA plan when you first become eligible for Medicare, you have 12 months to try it out. If you decide it's not for you, you can switch back to Original Medicare and have a guaranteed right to buy a Medigap plan.
This decision has long-term effects. For free, unbiased information, you can contact the state's counseling service, which locally is the Direction Home Akron Canton Area Agency on Aging — OSHIIP. For help with your specific situation and to compare the costs and networks of plans available right here in Uniontown, our team at BenefitsCompass Ohio is here to help. Use the form on this page to request a callback, and a licensed agent can walk you through the options that fit your doctors and budget.
Frequently asked questions
Can I have both a Medicare Advantage plan and a Medigap policy at the same time?
No, it is illegal for an insurance company to sell you a Medigap policy if they know you are enrolled in a Medicare Advantage plan. They are two mutually exclusive paths. Medigap works with Original Medicare (Parts A and B). Medicare Advantage is a replacement for Original Medicare. You must choose one path or the other. If you have a Medigap plan and decide to join a Medicare Advantage plan, you should drop your Medigap policy. You can always ask us for guidance before making a switch.
Do I still have to pay my Part B premium if I enroll in a Medicare Advantage or Medigap plan?
Yes, regardless of which option you choose, you must continue to pay your monthly Medicare Part B premium to Social Security. Think of the Part B premium as the entry fee to the Medicare system. If you stop paying it, you will lose all of your coverage—Part A, Part B, and your supplemental plan (either Medigap or Advantage). For most people, this premium is deducted directly from their Social Security benefit check. If you aren't yet drawing Social Security, you will be billed quarterly from the Canton SSA office located at 4150 Tuscarawas St W.
Are all Medigap Plan G policies sold in Ohio identical?
The benefits of a Medigap Plan G are standardized by the federal government. This means a Plan G from one company must cover the exact same 'gaps' in Medicare as a Plan G from any other company. However, the companies themselves are different. They differ in the monthly premium they charge for that same coverage, their history of rate increases over time, and their customer service reputation. Part of our job is to help you compare not just the plans, but the companies offering them in the Uniontown area to find a stable, reputable carrier.
What happens to my plan if I move out of Uniontown?
This depends entirely on the type of plan you have. If you have a Medigap plan, you can take it with you anywhere in the United States. Your coverage is not tied to your location. You would simply notify the insurance company of your new address. If you have a Medicare Advantage plan, your coverage is tied to a specific service area, usually a county or group of counties. If you move out of the plan's service area (for example, from Uniontown to Florida), you will trigger a Special Enrollment Period that allows you to enroll in a new Medicare Advantage or Part D plan in your new location.
How can I check if my specific doctors are in a Medicare Advantage plan's network?
This is a critical step before enrolling. You cannot assume your doctor is in-network. The most accurate way is to use the plan's online provider directory, which can be found on its website. You can also call the insurance company directly and ask them to check for you. A third option is to call your doctor's office and ask the billing department which specific Medicare Advantage plans they participate in for the upcoming year. As local agents, we have access to these tools and can perform this check for you across multiple plans at once.
Where can I get free, unbiased help reviewing my options?
The State of Ohio provides a free health insurance counseling program called OSHIIP (Ohio Senior Health Insurance Information Program). This is an excellent resource for impartial information and education about Medicare. For residents in the Uniontown and greater Stark County area, your local counseling site is the Direction Home Akron Canton Area Agency on Aging. Their trained volunteers can explain how Medicare works but cannot recommend a specific plan or company. As licensed agents, we can provide that next level of service by making specific plan recommendations based on your individual needs.
Serving Uniontown and nearby communities
We help Medicare-eligible residents across Uniontown, Hartville, Green, North Canton, and the rest of Stark County. Major hospital networks in this area include Mercy Medical Center, Cleveland Clinic. When you fill out the callback form, a licensed Ohio agent will check which plans cover your specific doctors and prescriptions.
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