Medicare Advantage vs. Original Medicare: What Each Costs and Covers
Original Medicare lets you see any doctor that takes Medicare but has no out-of-pocket cap. Medicare Advantage caps your costs but uses networks. Here is how the two paths compare, with the numbers.
| Original Medicare (+ Medigap + Part D) | Medicare Advantage | |
|---|---|---|
| Doctors and hospitals | Any provider in the U.S. that accepts Medicare | Usually a network (HMO or PPO); out-of-network care costs more or isn’t covered |
| Monthly premiums | Part B + Medigap premium + Part D premium | Part B + plan premium (often $0) |
| Out-of-pocket limit | None in Original Medicare alone; Medigap covers most or all of the gap | Required; up to $9,850 in-network in 2027 |
| Prior authorization | Rarely needed | Common for many services |
| Extra benefits | No routine dental, vision or hearing | Often some dental, vision, hearing and fitness |
| Travel | Covered anywhere in the U.S.; some Medigap plans cover emergencies abroad | Usually emergencies only outside the plan’s area |
| Switching later | You can move to Advantage at Open Enrollment | Moving back to Original + Medigap may require medical underwriting |
The cost trade-off
Medicare Advantage usually costs less in a healthy year: low or $0 premiums and modest copays. Original Medicare with a Medigap policy usually costs more each month but very little when you need a lot of care, and it doesn’t restrict you to a network. A simple test: add up the yearly premiums for each path, then add each one’s worst-case out-of-pocket costs. That gap is what you’re insuring against.
Run the test for your county
Pick your county to pull the 2027 Medicare Advantage plans and Part D premiums from CMS data, then enter a Medigap quote. Both paths include the Part B premium, minus any Part B giveback the Advantage plan files with CMS.
Choose your state and county
| Original + Plan G + Part D | Advantage |
|---|
Healthy year = premiums only (plus the Part B deductible for Plan G, which doesn’t cover it). Worst case = premiums + the most you could pay for covered medical care: the Part B deductible with Plan G, the plan’s in-network out-of-pocket maximum with Advantage. Drug costs are capped at $2,400 in 2027 on both paths, so they’re left out of both. Part B premium: $202.90 a month (2026; 2027 not announced yet). Out-of-network care in a PPO costs more. Nothing you type leaves your browser.
The decision that’s hard to undo
When you first get Part B at 65, you have a six-month Medigap Open Enrollment Period when insurers must sell you any Medigap policy at the standard price. After it ends, in most states an insurer can ask health questions and turn you down if you later leave Medicare Advantage. There are limited exceptions, such as a trial right in your first year of Advantage, and a few states give broader rights. If flexibility matters to you, weigh this before choosing Advantage at 65. Your Medigap rights, federal and by state.
Questions
Is Medicare Advantage cheaper than Original Medicare?
Often in premiums, not always in total. Advantage plans frequently have $0 premiums, but you pay copays and coinsurance up to the plan’s out-of-pocket limit. Original Medicare plus Medigap has higher premiums but very low costs when you use a lot of care.
Can I switch from Medicare Advantage back to Original Medicare?
Yes, during Open Enrollment (Oct 15–Dec 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). Getting a Medigap policy after that switch may require answering health questions, depending on your state and situation.
Do I still pay the Part B premium with Medicare Advantage?
Yes. You keep paying the Part B premium ($202.90 a month in 2026, more with IRMAA) plus any plan premium. Some plans reduce your Part B premium (“giveback” plans).
Sources
Official sources only, checked October 17, 2026.
- Medicare.gov, “Compare Original Medicare & Medicare Advantage” — medicare.gov.
- Medicare.gov, “Medigap & travel / guaranteed issue rights” — medicare.gov/health-drug-plans/medigap.
- CMS, CY 2027 Medicare Advantage maximum out-of-pocket limits.
- Calculator: CMS CY 2027 Medicare Advantage and Prescription Drug Plan Landscape (general-audience plans with drug coverage; stand-alone Part D premiums), cms.gov; 2026 Part B premium and deductible, cms.gov.
Educational information, not medical, legal or financial advice. We are not connected with or endorsed by the U.S. government or the federal Medicare program. · Advertiser disclosure