Medicare Advantage (Part C) and Original Medicare (Parts A and B) are two different ways to get your Medicare benefits — same government program, different delivery systems. Original Medicare lets you see almost any doctor or hospital in the country but leaves gaps that many people fill with a Medigap policy. Medicare Advantage bundles your hospital, medical, and usually drug coverage into one private plan with a limited network, often lower premiums, and a yearly out-of-pocket cap.
The Basic Structure
Original Medicare is run directly by the federal government. Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment. You pay a monthly Part B premium, an annual deductible, and then generally 20% coinsurance on most Part B services with no out-of-pocket maximum — unless you add a Medigap policy.
Medicare Advantage is Medicare delivered through private insurance companies approved by CMS. These plans must cover everything Original Medicare covers, and most also include Part D prescription drug coverage and extras like dental, vision, and hearing. In exchange, you typically use a network — an HMO or PPO — and need referrals or prior authorization for some services.
Cost Comparison
Cost is the number one question people ask, and the honest answer is: it depends on how much care you use.
For 2026, the standard Part B premium is $202.90 a month, and the Part B deductible is $283 a year, according to CMS.gov. The Part A inpatient hospital deductible for 2026 is $1,736 per benefit period. CMS adjusts these amounts every January, so always confirm the current year’s figures at Medicare.gov before you enroll.
With Original Medicare alone, there’s no cap on your 20% coinsurance — a long hospital stay or ongoing cancer treatment could cost thousands out of pocket. That’s why most people on Original Medicare also buy a Medigap (Medicare Supplement) policy, which covers some or all of that coinsurance for an additional monthly premium, typically ranging from roughly $100 to $300+ a month depending on your state, age, and the plan letter you choose.
Medicare Advantage plans work differently. Many charge $0 monthly premium beyond what you already pay for Part B, but you’ll pay copays for each doctor visit, test, or procedure. Every Medicare Advantage plan is required by law to have a maximum out-of-pocket limit — for 2026, CMS set the in-network cap at $9,250, though many plans set theirs lower (the 2026 average is around $5,400, per KFF). Once you hit your plan’s number, the plan pays 100% of covered services for the rest of the year.
Provider Access and Referrals
This is where the two paths diverge most sharply.
With Original Medicare, you can see any doctor or go to any hospital in the U.S. that accepts Medicare — and the vast majority do. No referrals are needed to see a specialist. This matters if you split time between two states, travel often, or have a specific doctor you don’t want to give up.
With Medicare Advantage, you’re generally limited to the plan’s network. HMO plans usually require you to pick a primary care doctor and get referrals for specialists; care outside the network typically isn’t covered except in emergencies. PPO plans allow some out-of-network care, but usually at a higher cost. Before enrolling in any Medicare Advantage plan, check its provider directory on the plan’s website or call to confirm your doctors and hospitals are actually in-network — directories can be outdated.
Prescription Drug Coverage
Original Medicare does not include prescription drug coverage. If you want it, you need to buy a standalone Part D plan separately. Most Medicare Advantage plans build drug coverage directly into the plan (called MA-PD), so you get medical and drug coverage in one card, one premium, one plan.
Since 2025, Part D has included a hard annual cap on out-of-pocket prescription drug costs — $2,100 for 2026, per CMS.gov — a significant change from prior years when there was no ceiling. This cap applies whether your drug coverage comes through a standalone Part D plan or through a Medicare Advantage plan with drug coverage built in.
Extra Benefits
Original Medicare covers what Congress has written into law — medically necessary care, with limited preventive and wellness benefits. It does not cover routine dental, vision, or hearing services.
Many Medicare Advantage plans advertise extras: routine dental cleanings, eyeglasses, hearing aids, gym memberships (often through programs like SilverSneakers), and sometimes allowances for over-the-counter items or groceries. These benefits vary enormously by plan and by county — a plan available in one zip code may not exist in the next one over. Use the Medicare Plan Finder at Medicare.gov to compare exact benefits available where you live before assuming any extra is included.
Enrollment and Switching
You can move between Original Medicare and Medicare Advantage at specific times:
- Initial Enrollment Period: the 7-month window around when you turn 65.
- Annual Enrollment Period: October 15 through December 7 each year, when you can switch from Original Medicare to Medicare Advantage, switch back, or change Medicare Advantage plans, effective January 1.
- Medicare Advantage Open Enrollment Period: January 1 through March 31, for people already in a Medicare Advantage plan who want to switch to a different Medicare Advantage plan or go back to Original Medicare (and pick up a Part D plan) once during that window.
One detail that trips people up: if you drop Medigap to join Medicare Advantage and later want to switch back to Original Medicare, you may not have a guaranteed right to buy a Medigap policy again — insurers in most states can medically underwrite you outside of specific protected periods. Check your state’s rules; some states, like New York and Connecticut, offer broader guaranteed-issue protections. Confirm details with your State Health Insurance Assistance Program (SHIP) before making a switch.
Side-by-Side Comparison
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Who runs it | Federal government | Private insurers under CMS contract |
| Monthly premium | Part B premium ($202.90/mo in 2026) + Medigap if purchased | Often $0 extra, but varies by plan |
| Out-of-pocket cap | None, unless you add Medigap | Yes, required by law ($9,250 in-network max for 2026) |
| Provider access | Any Medicare-accepting doctor/hospital nationwide | Limited to plan network, often needs referrals |
| Drug coverage | Not included; buy separate Part D | Usually included (MA-PD) |
| Extra benefits (dental, vision, hearing) | Not covered | Often included, varies by plan and county |
| Referrals needed | No | Often yes, especially HMOs |
| Travel coverage | Full nationwide coverage | Limited outside network except emergencies |
Which One Fits Which Situation
Original Medicare with a Medigap policy tends to suit people who travel frequently, have specialists they want to keep seeing regardless of network, or simply prefer predictable costs without worrying about referrals. The tradeoff is a higher combined monthly premium for Part B plus Medigap.
Medicare Advantage tends to suit people comfortable with a network, who want dental/vision/hearing bundled in, and who want a hard cap on their annual medical spending without paying a separate Medigap premium. The tradeoff is less flexibility if you move, travel, or want an out-of-network specialist.
Neither choice is permanent, but switching back and forth has real consequences — especially around Medigap underwriting — so it’s worth thinking through your health needs, travel habits, and budget before you decide, not just comparing this year’s premium.
How to Get Personalized Numbers
Because costs and plan benefits differ by county, the only reliable way to compare real numbers for your situation is the official Medicare Plan Finder at Medicare.gov. You can enter your medications and doctors to see actual estimated costs under different plans available where you live. You can also call 1-800-MEDICARE or your local SHIP counselor for free, unbiased help — they don’t sell insurance and won’t push you toward any particular plan.
FAQ
Can I switch from Medicare Advantage back to Original Medicare?
Yes. You can switch during the Annual Enrollment Period (October 15–December 7) or the Medicare Advantage Open Enrollment Period (January 1–March 31) if you’re already in an MA plan. Keep in mind that regaining a Medigap policy afterward isn’t guaranteed in most states unless you qualify for a specific protected enrollment period — check with your State Health Insurance Assistance Program.
Is Medicare Advantage cheaper than Original Medicare?
It depends on how much care you use. Many Medicare Advantage plans have $0 extra premium and bundle drug and extra benefits, but you’ll pay copays per service up to an annual out-of-pocket cap ($9,250 in-network max for 2026). Original Medicare has no built-in cap, so people often add a Medigap policy, which raises the monthly premium but can lower or eliminate coinsurance. Run your specific numbers on Medicare.gov’s Plan Finder.
Do all Medicare Advantage plans include prescription drug coverage?
Most do, but not all — always confirm before enrolling. If a Medicare Advantage plan doesn’t include drug coverage and you don’t already have other creditable drug coverage, you could face a late enrollment penalty later if you sign up for Part D afterward. Check the plan’s Summary of Benefits on Medicare.gov to confirm.
Sources
- Medicare.gov — https://www.medicare.gov
- CMS.gov — https://www.cms.gov
- Medicare Plan Finder — https://www.medicare.gov/plan-compare
- State Health Insurance Assistance Program (SHIP) locator — https://www.shiphelp.org
Related reading
- Social Security COLA for 2026: How Much Bigger Will Your Check Be?
- Medicare Open Enrollment: Dates, What You Can Change, and Costly Mistakes