Why Doctors Prefer Patients with Medigap Plans

When you are selecting a Medicare plan, you focus on premiums, benefits, and out-of-pocket costs. What many people do not consider is how their insurance choice affects the care they receive, starting with whether their doctor wants to see them at all. If you want the bigger picture on these tradeoffs, our overview of why some experts say Medicare Advantage Plans fall short is a good starting point.

Here is something many Medicare beneficiaries do not know: many doctors prefer, or even require, that patients have Medigap rather than Medicare Advantage. And the reasons are instructive.

How Billing Works: Medigap vs. Medicare Advantage

To understand why doctors have a preference, it helps to understand how payment works.

With Original Medicare Plus Medigap

When you have Original Medicare plus a Medigap plan and you see a doctor who accepts Medicare:

Your doctor submits a single Claim to Medicare
Medicare pays its share (typically 80%)
The Medigap insurer pays its share (typically the remaining 20%)
You owe nothing beyond the monthly Premium once the Part B Deductible is met (with Plan G). Plan N has a similar structure but also includes copayments of up to $20 for some office visits and up to $50 for ER visits that don’t result in an inpatient stay, and does not cover Part B Excess charges.

The doctor deals with one payer, Medicare, and then one supplemental payer. In most cases, Medigap insurers pay automatically through crossover billing. They receive claim information directly from Medicare and pay the patient’s share without requiring Prior authorization or separate claims submission. Whether you have Plan G or another standardized plan, Medigap is straightforward secondary insurance.

With Medicare Advantage

When you have Medicare Advantage and you see a provider:

Your doctor must be in the plan’s network (or you face higher costs)
Your doctor submits a claim to the private Medicare Advantage insurer
The insurer pays according to its own fee schedule, which may differ from Medicare’s standard rates
The insurer may require prior authorizations for certain services before care is given
The insurer may conduct post-claim reviews and request refunds of payments already made

The doctor now deals with a private insurance company, one that can impose complex administrative requirements, pay different rates, and deny or claw back payments. Different Medicare Advantage plans have different rules, different networks, and different fee schedules. A practice dealing with multiple MA plans faces significant administrative complexity.

The Administrative Burden Problem

Dealing with prior authorizations is one of the largest administrative burdens on medical practices today. For a closer look at how this process affects patients directly, see our guide on prior authorization under Medicare Advantage.

A 2022 American Medical Association (AMA) survey found that physicians and their staff spend an average of nearly 14 hours per week managing prior authorization requirements. That is the equivalent of over half a full workday every week, time that could be spent seeing patients.

For practices with many Medicare Advantage patients, this burden is substantial. A denied prior authorization requires the practice to:

Appeal the decision
Coordinate with the plan’s clinical reviewer
Document Medical necessity repeatedly
Sometimes wait days or weeks for resolution, while the patient waits for care

With Medigap patients, essentially none of this exists. If Medicare covers it, it is covered. The practice submits the claim and is paid.

Why Some Doctors Limit Medicare Advantage Acceptance

The administrative complexity and rate concerns have led some practices to limit the Medicare Advantage plans they accept.

This is not universal: many practices accept a wide range of MA plans. But the trend is real, particularly among:

Specialists and subspecialists. High-demand specialists, including oncologists, cardiologists, neurosurgeons, and orthopedic surgeons, can be selective about which insurance they accept. Some choose not to accept certain MA plans, particularly those that pay significantly below Medicare rates or impose heavy prior authorization burdens.

Major academic medical centers. Prestigious cancer centers and academic hospitals sometimes do not participate in certain or all Medicare Advantage networks. Patients who go to one of these centers expecting MA coverage may find they are out-of-network.

Small independent practices. Practices without large billing departments may decline to participate in MA plans that create excessive administrative work.

With most Medigap plans and Original Medicare, you can see any doctor who accepts Medicare. No network check required.

(Note: Medicare Select, a very uncommon type of Medigap, does require use of network hospitals and sometimes doctors for full benefits.)

What Patients Experience

The practical effect of all this is something Medigap patients rarely notice, and Medicare Advantage patients sometimes notice acutely.

Medigap patient experience:

Schedule appointment with any Medicare-accepting doctor
Show Medicare card and Medigap card at check-in
Receive care
Pay nothing (or just the deductible if applicable)
Done

Medicare Advantage patient experience (at its worst):

Check whether doctor is in-network
Get Referral from Primary care physician (if HMO)
Provider submits prior authorization request for procedure
Wait for authorization decision
Possibly receive denial and begin appeal process
Navigate different copay structures depending on service type
Deal with unexpected bills if any step goes wrong

When you are healthy and using routine care, Medicare Advantage can work fine. When you are seriously ill and need complex care, the barriers become more consequential.

What Doctors Say

Physicians rarely make public statements about preferring certain types of patients’ insurance: they have professional obligations to all patients. But surveys and health system behaviors tell the story.

AMA surveys consistently find that physicians view prior authorization as having a negative impact on patient care. A 2023 AMA survey found that 94% of physicians believe prior authorization delays access to necessary care, and 33% said prior authorization had led to a serious adverse event for one of their patients.

Healthcare systems and academic medical centers make network participation decisions based on a range of factors, including administrative burden and payment adequacy. When hospitals choose not to participate in a Medicare Advantage network, they are, in effect, making a statement about the terms of that plan.

Patient access issues documented in Medicare Advantage are well-studied. Multiple analyses have found that beneficiaries in Medicare Advantage face more access barriers than those in Original Medicare, particularly for specialty care.

Does This Mean Medicare Advantage Is Always the Wrong Choice?

No. Medicare Advantage works well for many people, particularly:

Those in good health who use minimal care
Those who value the added benefits (dental, vision, hearing) that some MA plans offer
Those in areas with high-quality MA plan options and broad networks
Those on fixed budgets who cannot manage a Medigap premium

The case for Medigap is strongest for people who:

Have complex or chronic health conditions requiring specialist care
Want to access specific doctors, hospitals, or cancer centers
Travel frequently or split time between states
Value predictable costs and want to avoid surprises
Prefer to have their doctor, not an insurer, direct their care

The Access Issue Becomes More Important With Age

Here is a dynamic worth noting: your healthcare needs typically increase as you age. The 65-year-old who chose Medicare Advantage because of the low premium and good health may face very different circumstances at 72 or 78.

At that point, when you need an oncologist at a major cancer center, a cardiologist at a top cardiac program, or a rehabilitation facility with the best outcomes, you want to know your coverage will follow you.

With Medigap, it will. With Medicare Advantage, it depends on whether those providers are in your network.

And switching from Medicare Advantage to Medigap at that point requires passing medical Underwriting, which may be difficult or impossible given health conditions accumulated over those years.

This is why many people who start on Medicare Advantage in good health, and then try to switch to Medigap later, struggle to do so.

Frequently Asked Questions

My doctor told me she “prefers” patients with Medigap. What does that mean?
It likely reflects the administrative simplicity of treating Original Medicare patients compared to Medicare Advantage patients. It does not mean she will not treat you if you have MA, but it may reflect her experience with the administrative burden.

Are there doctors who will not see Medicare Advantage patients at all?
Some practices limit or do not accept certain MA plans, while accepting Original Medicare. This is more common with certain specialties and high-demand practices. Before selecting an MA plan, confirm your current doctors are in-network.

My doctor is in my Medicare Advantage plan’s network. Am I protected?
For routine care, yes. For specialty care, it depends on whether the specialist you need is also in-network. Networks can change annually, your doctor may be in-network this year but not next year.

Does Medigap always cover what Original Medicare covers?
Medigap covers the cost-sharing associated with Original Medicare-covered services. If Medicare covers a service, Medigap covers the applicable portion of the patient’s cost. If Medicare does not cover something (like routine dental or vision), Medigap does not cover it either.

Bottom Line

Doctors prefer treating Medigap patients for real, practical reasons: simpler billing, no prior authorization, predictable payment, and fewer administrative barriers. This preference translates directly into easier access to care, particularly for specialized or complex treatment.

When you are evaluating Medicare options, consider not just your current health needs but your future ones, and ask which type of coverage will give you the access and freedom you want if your health becomes more complex. If you are still weighing your options, our comparison of Medicare Advantage vs. Medicare Supplement plans can help you decide which path fits your needs.

REMEDIGAP’s licensed advisors can help you evaluate your specific situation and find the right Medigap plan for your needs.

This article is for educational purposes. Medicare Advantage plan networks, prior authorization policies, and physician participation rates vary and change annually. Verify details with your specific plan or providers.

Michael Quinn

Michael Quinn is a licensed Medicare insurance expert and cofounder of REMEDIGAP. With over a decade of experience, he helps people compare coverage options with clear, unbiased guidance. His insights have been featured by USA Today, NerdWallet and many other publications.