By Mario Cruz Pérez Licensed Independent Insurance Agent · 16 states (including Texas) · NPN listed on his profile page

Last updated: June 1, 2026

More about Mario → https://supermarioinsurance.com/sobre-mario-cruz/

If you’re comparing Medicare Advantage vs Medigap in 2026 and nobody has explained the difference clearly, this article is for you. You won’t read the insurance company’s version here, or the version of a salesperson who earns a bigger commission on one of the two routes. You’ll read the version of an independent agent licensed in Texas, with more than 13 years of experience working with Hispanic families in Houston, who is also a real Medicare Advantage member.

I’ll show you the 2026 numbers, the protection almost nobody explains to you (it’s called the MOOP), why the network freedom of a Medigap plan sounds better than it really is for many Hispanics in Houston, and a real case of one of my clients, Don Roberto, whose plan review completely changed what he paid each month.

At the end you’ll find a frequently asked questions section and a button to send me the word REVISA on WhatsApp if you’d like us to review your case at no cost. Below is the video version of this guide (in Spanish).

The Two Medicare Routes: How They Really Work

When you turn 65 (or qualify through disability), you have two main routes for organizing your Medicare coverage. Neither one is good or bad. They’re different. And the one that fits you depends on your particular case: your doctors, your medications, your county, your health and your budget.

Route 1: Medicare Advantage (Part C)

This is a private plan approved by Medicare that combines your Part A, your Part B and usually your Part D into a single plan. Many plans have a $0 additional plan premium. And many include extra benefits: dental, vision, hearing, transportation to medical appointments, an OTC card for health products and, in some cases, a Giveback, which is a partial refund of your Part B premium (the exact amount varies by plan and region, and not every plan offers it).

Route 2: Original Medicare + Medigap (Supplement)

Here you keep the government’s Parts A and B and separately buy a Medigap plan to cover the gaps that Original Medicare doesn’t pay. On top of that, you have to buy a separate Part D plan for your medications and, if you want them, dental, vision and hearing plans, because Medigap does NOT include any of those benefits.

Medicare Advantage vs Medigap Costs in 2026: The Numbers That Matter

Here is the comparison almost nobody shows you in full. These are typical costs for a Hispanic beneficiary aged 65-70 in the Houston area in 2026. The standard Part B premium in 2026 is $202.90 per month for most beneficiaries. That amount may be different if your income is above certain limits (IRMAA) or if you qualify for assistance programs such as Extra Help.
Monthly item Medicare Advantage Medigap (Supplement)
Part B premium (government) $202.90* $202.90*
Additional plan premium $0 on many plans $149 – $250+ depending on age and state
Part D (prescriptions) Included in most plans Separate plan required
Dental, vision and hearing Included in many plans Separate policies at your cost
Typical monthly total ≈ $202.90 ≈ $350 to $500 or more
When you pay more When you use services (copays) Every month, whether you use it or not

*Standard 2026 Part B premium for most beneficiaries. People with income above certain limits pay IRMAA (a higher amount). People with Extra Help, MSP or Medicaid may have part of the premium covered.
The simple rule: with Advantage, you pay when you use it. With a Supplement, you always pay. That’s the difference that changes the math for most of the Hispanic families I serve.

MOOP: The Medicare Advantage 2026 Protection Almost Nobody Explains

MOOP stands for Maximum Out-of-Pocket: the most you will pay out of your own pocket during the calendar year. With a Medicare Advantage plan, you never pay more than that ceiling for covered in-network services in a year, no matter how many times you are hospitalized or how many surgeries you have.

In the Houston area, 2026 Advantage plans have typical MOOPs between $3,000 and $5,500 in-network. There is a higher federal regulatory cap ($9,250 in-network for 2026), but that is the regulatory ceiling, not the typical amount. Most competitive plans in Harris County stay well below that cap.

Why does it matter so much? Because with Original Medicare alone, without a Medigap plan on top, there is no ceiling at all. The 20% Part B coinsurance has no limit. The 2026 Part A hospital deductible is $1,736 per benefit period (not per year). If you are hospitalized in January and again in May, you pay TWO deductibles. With Advantage, you reach your MOOP once and the plan pays for the rest of the year.

Medigap also solves that problem, but in exchange for a fixed monthly premium that you pay whether you use services or not. For a healthy person who rarely goes to the doctor, that fixed cost adds up. For a person with chronic conditions who uses the system constantly, that fixed cost may be worth it. That’s the real decision.

The Difference Between Medicare Advantage and Medigap for Hispanics in Houston

This is the cultural part that an agent who doesn’t serve the Hispanic market won’t explain to you. The question isn’t just “which route is better in theory.” The question is: which route fits the way your family actually uses the health care system?

The Classic Argument for a Supplement: Network Freedom

“With Medigap I can go to any doctor in the United States.” True. With Original Medicare + Medigap you can see any doctor or hospital in the country that accepts Medicare.

The Reality for Hispanics in Houston

The vast majority of the clients I serve in Harris, Fort Bend and Montgomery counties use local doctors. Your primary care doctor is in your neighborhood. Your specialist is here. Your pharmacy is here. Your children drive you to your appointments and work in Houston.

Paying $200 or $300 extra per month for nationwide network freedom that you might use once in 5 years is a decision worth making with numbers, not with fear. And for emergencies outside Texas, Advantage plans cover emergency care at any hospital in the country. Some even cover emergencies outside the United States.

When a Supplement Does Fit in My Practice

I’m not going to tell you that Advantage is the answer for everyone. There are profiles where a Supplement fits the situation better. For example: a grandmother with four daughters in four different states who spends three months a year with each one. That person needs nationwide network freedom, and the extra cost is justified. Or someone with a complex chronic condition who prefers a predictable monthly cost over variable copays. Those cases exist. That’s why every decision is individual.

A Real Case: A Plan Review That Changed the Numbers for a Client

A client of mine in southwest Houston (I call him Don Roberto to protect his privacy) had been on a Medigap Plan G for 4 years. He was paying $387 a month just for the Medigap. Plus his Part D. Plus his $202.90 Part B. Total: more than $600 a month.

In 4 years he went to the doctor about 6 times. That added up to roughly $30,000 paid in premiums to use the system 6 times.

When we reviewed his case in a 25-minute appointment, we found that all of his doctors accepted a Medicare Advantage plan with a $0 additional plan premium. All of his medications were on the formulary. That plan added dental, vision, transportation to appointments and a monthly OTC card. Don Roberto went on to pay only his Part B. The yearly difference was significant for his family budget.

Did the Supplement serve him for a while? Yes. Did it fit his current situation? After reviewing the numbers together, we decided that a different plan fit his real use of the system better. And you only discover that when an independent agent who represents several companies sits down to do the full analysis. Calling a single insurance company directly will never show you that comparison.

Note: Don Roberto is a real client whose name has been changed to protect his privacy. Benefits, costs, premiums, provider networks, drug formularies and savings vary by plan, carrier, county, state and each beneficiary’s individual situation. This case illustrates a review process; it is not a projection of results for your case.

Medicare Advantage or Medigap: How to Decide Which One Fits Your Situation

There is no universal answer. There is an answer for your case. The decision depends on five concrete questions:
Who are your current doctors, and do they accept the Advantage plans in the county where you live?
Which medications do you take, and on which formulary are they covered with the lowest copay?
How often do you use the health care system each year? Are you a healthy, moderate or heavy user?
Do you travel outside Texas for more than three months a year, or do you have family in other states?
Do you qualify for any assistance program (Medicaid, LIS, Extra Help) that could cover part of your Part B or Part D?

You can’t answer those five questions with an online calculator. You answer them in a free review with an independent agent who represents several companies, knows Houston’s Hispanic market and sits down with you and your family. That’s the conversation I offer.

Review Your Medicare Plan for Free, With No Obligation

If you want to know whether the route you have today fits your situation, I can help. The review is free for you because my compensation comes from the insurance carrier when I enroll you, not from the client.

Review Your Medicare Plan for Free, With No Obligation

If you want to know whether the route you have today fits your situation, I can help. The review is free for you because my compensation comes from the insurance carrier when I enroll you, not from the client.

I serve clients in English and Spanish. Office in Katy, Texas.

Frequently Asked Questions About Medicare Advantage vs Medigap

Can I switch from Medicare Advantage to Medigap whenever I want?

Not always. When you first enroll in Medicare, you have a guaranteed window to buy Medigap without medical underwriting. After that window, in most states the insurance company can ask for your medical history and turn you down for pre-existing conditions. That’s why your first decision matters so much. If you’re thinking about switching, let’s talk before you make a move.

What is the difference between Medicare Advantage and Medigap, in a nutshell?

Medicare Advantage is a private plan that replaces the way you receive your Medicare benefits and bundles Part D and extra benefits into one plan, usually with a doctor network and copays when you use services. Medigap is a separate policy that covers the gaps in Original Medicare, adds no new benefits, and is paid every month whether you use services or not.

Is it true that Medicare Advantage costs less than Medigap?

In many cases, yes, when you count the total monthly cost (Part B premium + plan premium + Part D + dental, vision and hearing). But the final cost depends on how many services you use each year. If you use the system constantly, Advantage copays add up, although the MOOP puts a cap on them. Every case needs its own calculation.

What is the MOOP in Medicare Advantage 2026, and how much is it?

The MOOP is the maximum you will pay out of pocket in a calendar year for covered in-network services. Once you reach that ceiling, the plan pays 100% for the rest of the year. In the Houston area, typical 2026 MOOPs range from $3,000 to $5,500 in-network, depending on the plan you choose.

Does Medigap include dental, vision and hearing?

No. Medigap only covers the gaps in Original Medicare (deductibles, copays, coinsurance). If you want dental, vision or hearing coverage with Medigap, you have to buy separate policies and pay for them separately. In contrast, many Medicare Advantage plans in the Houston area already include those benefits at no additional plan cost.

Can I keep my current doctors with Medicare Advantage?

It depends on whether your doctors are in the network of the plan you choose. Before you enroll, we check every doctor, specialist and pharmacy you use, one by one. That check is part of the free service I offer. If your doctors are not in any Advantage plan in your county, that’s where a Medigap plan may be the option that fits your case best.

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Mario Cruz, licensed agent in 16 states. This information is educational and is based on information from qualified carriers the agency has contracts with. We do not offer every plan available in your area. For a personalized review of your case, call me at 832-789-3845 or message me on WhatsApp at 346-574-6912. For all of your options, call 1-800-MEDICARE (TTY 711) or visit Medicare.gov.

This content is educational. It is not marketing or a recommendation of a specific plan. Benefits, costs, premiums, provider networks, drug formularies and plan features vary by plan, county, state and the beneficiary’s individual situation. Mario Cruz Pérez is an independent agent licensed in Texas and 15 additional states. We are not affiliated with or endorsed by Medicare or the Federal Government. We do not offer every plan available in your area. We represent multiple organizations that offer Medicare Advantage and Medicare Supplement products in your area. For a complete list of all your options, call 1-800-MEDICARE (TTY 711), visit Medicare.gov, or contact your local State Health Insurance Assistance Program (SHIP). The information presented is current for the 2026 plan year according to CMS regulations available at the time of publication. The cases described are illustrative. Names and personal details have been changed to protect client privacy. For a personalized review of your specific situation, contact a licensed agent. Mario Cruz Insurance Agency Inc., Katy, Texas.