Key takeaway
According to the Centers for Medicare & Medicaid Services (CMS), the 2026 standard Part B premium is $202.90 a month, the floor every enrollee pays. Medicare Advantage typically adds extra benefits (dental, vision, hearing) but restricts you to a provider network; Original Medicare offers any-provider freedom and pairs with Medigap for more predictable costs, but you pay more for the flexibility. See our methodology for how plan data is sourced.
Medicare Advantage vs Original Medicare
When you first become eligible for Medicare, you make a foundational choice: enroll in Original Medicare (Parts A + B), or choose Medicare Advantage (Part C). Each path carries real advantages and real drawbacks, and the right answer depends on your health, budget, and how often you travel.
The Basics: What Each Covers
Original Medicare (Parts A & B)
Government-administered insurance covering:
- Part A: Hospital stays, skilled nursing facility care, home health care, hospice
- Part B: Doctor visits, outpatient care, preventive services, some medical equipment
Does not cover: Prescription drugs (need separate Part D), routine dental, vision, hearing, or long-term care.
Medicare Advantage (Part C)
Private insurance bundling Part A + B coverage (often with Part D drugs) into one plan, plus usually adding:
- Prescription drug coverage (Part D)
- Dental, vision, hearing benefits
- Fitness programs, transportation, OTC allowances
Must cover everything Original Medicare covers, but can use different cost-sharing structures and networks.
Side-by-Side Comparison
| Factor | Original Medicare | Medicare Advantage |
|---|---|---|
| Monthly Premium | Part B: $202.90/mo (2026). Medigap: $50–$400+/mo | $0 to $150+/mo (varies by plan/county) |
| Provider Choice | Any provider accepting Medicare, nationwide | Usually limited to plan's network; higher cost out-of-network |
| Out-of-Pocket Cap | No cap (Medigap adds protection) | Required by law; max $9,250 in-network (2026) |
| Referrals | Not required | Required by some HMOs; not required for PPOs |
| Dental/Vision/Hearing | Not covered (need separate plans) | Usually included (varies by plan) |
| Prescription Drugs | Need separate Part D plan | Usually bundled (check formulary) |
| Travel Coverage | Covered nationwide | Emergency care covered; routine care may not be |
| Star Quality Rating | N/A | CMS 1–5 star rating per plan |
When Original Medicare May Be Better
- You want the freedom to see any Medicare-accepting provider anywhere in the country without a referral
- You travel frequently or live in two states seasonally
- You have a serious or complex health condition requiring specialized care at specific hospitals
- You can afford a Medigap supplement to cap your out-of-pocket expenses
- You live in an area with few or low-quality Medicare Advantage plan options
When Medicare Advantage May Be Better
- You want lower monthly premiums and are comfortable within a network
- You want dental, vision, hearing, and other extras bundled in one plan
- You have a specific chronic condition and want a plan designed around managing it (SNP)
- You want a predictable out-of-pocket maximum to protect against catastrophic costs
- High-quality plans (4–5 stars) are available in your county
The Role of Medigap (Medicare Supplement Insurance)
If you choose Original Medicare, you can add a Medigap policy to cover the gaps, including the Part A and Part B coinsurance, deductibles, and hospital costs. Medigap policies provide predictable out-of-pocket costs but come with additional monthly premiums.
Important: You cannot have both Medicare Advantage and Medigap. They are mutually exclusive.
Sources
- Medicare.gov. Original Medicare vs Medicare Advantage.
- CMS. Medicare & You 2026. cms.gov
- KFF. Medicare Advantage 2026 Spotlight.
Frequently Asked Questions
Can I switch from Medicare Advantage back to Original Medicare?
Yes. During the Annual Enrollment Period (October 15 – December 7) you can disenroll from Medicare Advantage and return to Original Medicare. However, if you want a Medigap supplement, be aware that in most states insurers can charge more or deny coverage based on pre-existing conditions if you don't enroll during a guaranteed issue period.
Does Medicare Advantage cover care when I travel?
Most Medicare Advantage plans cover emergency care nationally, but routine care outside your plan's service area may not be covered (or may cost more). If you travel frequently or split time between states, Original Medicare with a Medigap policy may offer more flexibility.
What is the out-of-pocket maximum for Medicare Advantage?
By law, Medicare Advantage plans must set a maximum out-of-pocket limit for in-network services. In 2026, the CMS maximum is $9,250 for in-network care (and higher for combined in/out-of-network). Once you reach this cap, the plan pays 100% of covered services for the rest of the year. Original Medicare has no cap.
Do I need a referral to see a specialist?
It depends on the plan type. HMO plans generally require referrals from your primary care doctor to see specialists. PPO plans typically don't require referrals. Original Medicare never requires referrals.
Is Medicare Advantage available everywhere?
Medicare Advantage plans are not available in every county. Rural areas often have fewer plan options. Some counties may have only one or two plans, while major metro areas may have dozens. Use PlainMedicare to check what's available in your county.
