Medicare Advantage vs Original Medicare
Original Medicare (Part A + Part B)
Part A (hospital insurance): $0 premium for most (if you paid Medicare taxes for 10+ years). Part B (medical insurance): $174.70/month standard premium in 2026 (higher for high earners via IRMAA). Deductible: $257/year (Part B, 2026). Coinsurance: 20% of most services. No out-of-pocket maximum. To fill coverage gaps, most people add a Medigap (Medicare Supplement) plan and a Part D drug plan.
Medigap (Medicare Supplement)
Private insurance that covers the 20% coinsurance and deductibles that Original Medicare doesn't pay. Standardized plans (A through N). Most popular: Plan G (covers everything except the Part B deductible). Monthly premium: $100-300/month depending on age, location, and plan. Guaranteed issue rights: When you first enroll in Medicare Part B (Medigap Open Enrollment Period — 6 months), you can buy any Medigap policy regardless of health. After that, insurers can medically underwrite (deny coverage or charge more based on pre-existing conditions).
Medicare Advantage (Part C)
Private insurance alternative to Original Medicare. Bundles Part A, Part B, and usually Part D into one plan. Must cover everything Original Medicare covers. Many plans offer extra benefits: dental, vision, hearing, gym memberships, and even over-the-counter allowances.
Premiums: Many plans have $0 monthly premium (you still pay Part B premium). Cost sharing: Copays ($5-50 per visit) rather than 20% coinsurance. Out-of-pocket max: $8,850 max (2026) — provides cost certainty. Networks: HMO (must use in-network providers, need referral for specialists) or PPO (out-of-network costs more, no referral needed).
Key Differences
| Factor | Original Medicare + Medigap | Medicare Advantage |
|---|---|---|
| Monthly Premium | Part B ($174.70) + Medigap ($100-300) + Part D ($30-80) = $300-550 | Part B ($174.70) + $0-100 plan premium = $175-275 |
| Out-of-Pocket Max | None (unlimited) | $8,850 max (2026) |
| Provider Choice | Any doctor or hospital accepting Medicare nationwide | Network (HMO/PPO). Out-of-network costs more or not covered |
| Referrals | No referrals needed | Often required (HMO) |
| Pre-Existing Conditions | Guaranteed issue only in first 6 months | Must accept you (but network limitations) |
| Travel Coverage | Good nationwide. Limited abroad (Medigap plans C-G cover foreign travel emergency 80%) | Limited to network. Emergency coverage abroad varies |
| Extra Benefits | None included | Often includes dental, vision, hearing, gym |
| Annual Changes | Stable (Medigap plans don't change benefits year to year) | Networks, copays, and drug formularies change annually |
Part D (Prescription Drug Coverage)
Original Medicare requires a separate Part D plan ($30-80/month). Medicare Advantage plans usually include Part D (MAPD plans). The 2025 inflation cap: $2,000 maximum out-of-pocket on drugs. The "donut hole" (coverage gap) was eliminated in 2025.
Which Should You Choose?
Original Medicare + Medigap is better if: You have complex or chronic health conditions, want to see any specialist without referrals, travel frequently within the US, want predictable costs, or prefer to avoid network restrictions. Also better if you have the budget for higher premiums.
Medicare Advantage is better if: You're healthy, want to minimize monthly premiums, want an out-of-pocket maximum, value extra benefits (dental, vision, gym), are comfortable with network restrictions, and live in an area with a highly rated Medicare Advantage plan available.
Important Considerations
- Switching back: Outside the Medigap Open Enrollment Period, you may not be able to switch from Medicare Advantage back to Original Medicare + Medigap without medical underwriting — and you could be denied or charged more due to health conditions.
- Medicare Advantage trial right: If you first choose Medicare Advantage, you have a 12-month "trial right" to switch back to Original Medicare and buy any Medigap policy. After 12 months, guaranteed issue rights vary by state.
- State-specific rules: Some states (NY, CA, MA, CT, ME, WA, OR, ID) have guaranteed issue rights year-round or annually.
- Star Ratings: Medicare rates Advantage plans 1-5 stars. Choose 4+ star plans when possible.