Original Medicare vs Medicare Advantage: 2026 Cost and Coverage

Premium math

Original Medicare: Part B $206.50 + Part D $36.78 + Medigap Plan G ~$165 = around $408 per month per person. Medicare Advantage: Part B $206.50 + plan premium ~$35 = around $242 per month. Headline savings of $166/mo with Advantage.

Out-of-pocket exposure

Original with Plan G: After the $257 Part B deductible, almost everything is covered. Catastrophic year cost: still around $408/mo. Medicare Advantage: copays per service, max out-of-pocket usually $4,000-$8,500 in-network. Catastrophic year cost: full out-of-pocket max plus monthly premiums.

Network

Original Medicare: any provider that accepts Medicare nationwide, no referrals, no prior authorization for most services. Medicare Advantage: HMO or PPO networks, often in-state only, prior authorization on many specialists and diagnostic tests.

Extras

Original Medicare offers no dental, vision, hearing, or fitness. Medicare Advantage typically bundles all four (varies by plan). For someone using all four, the bundled value can be $1,000-$2,000 per year.

Switching

Original Medicare ↔ Medicare Advantage swap is allowed during the Annual Election Period (Oct 15 - Dec 7). But returning to Original from Advantage may face Medigap medical underwriting, which can deny or surcharge people with pre-existing conditions. The one-time guaranteed-issue right at age 65 is the easiest entry to Original. Decide carefully at 65.

Verdict

Healthy retirees who stay in one state, use mainstream providers, and want low monthly costs lean Medicare Advantage. Retirees who travel, want predictable catastrophic-year costs, value provider freedom, or have chronic conditions lean Original + Medigap.