Medicare Advantage vs. Original Medicare

Side-by-Side Comparison

Feature	Original Medicare	Medicare Advantage
Monthly premium	Part B: $202.90/mo (2026)	$0 – $200+ (plus Part B)
Out-of-pocket maximum	None (without Medigap)	Up to $9,350/year (2025)
Provider choice	Any Medicare-accepting provider	Usually limited to network
Referrals needed	No	Often yes (HMO plans)
Prescription drugs	Requires separate Part D plan	Usually included
Extra benefits (dental, vision)	Not covered	Often included
Medigap eligibility	Yes	No (while in MA plan)
Coverage outside the U.S.	Limited	Very limited

When Original Medicare May be Better

Original Medicare (with a Medigap supplement) may be the better choice if you:

Want maximum provider flexibility - see any doctor or specialist who accepts Medicare, anywhere in the U.S.
Have complex health needs requiring multiple specialists or frequent hospitalizations
Travel frequently and need coverage in multiple states or abroad
Want predictable, low out-of-pocket costs (with a comprehensive Medigap plan like Plan G)
Have doctors you want to keep who don't participate in Medicare Advantage networks

When Medicare Advantage May be Better

Medicare Advantage may be the better choice if you:

Want to minimize monthly premiums (many plans are $0/month)
Want extra benefits like dental, vision, hearing, and fitness programs
Are generally healthy and don't use a lot of healthcare services
Have a limited budget and want an out-of-pocket maximum to protect against catastrophic costs
Are comfortable with a network of providers and managed care approach
Qualify for a Special Needs Plan (D-SNP, C-SNP) that coordinates your specific benefits

Switching between Medicare Advantage and Original Medicare

You can switch between Medicare Advantage and Original Medicare during the Annual Enrollment Period (Oct 15–Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31).

Important caveat: If you switch back to Original Medicare after being in a Medicare Advantage plan, you may have difficulty getting a Medigap (Medicare Supplement) plan. Outside of guaranteed issue periods, Medigap insurers can use medical underwriting and deny coverage or charge higher premiums based on your health history. This is one of the most important factors to consider when making the initial Medicare coverage decision at age 65.

Frequently Asked Questions

Which is Cheaper, Medicare Advantage or Original Medicare?

It depends on your health usage. Medicare Advantage often has lower monthly premiums, but Original Medicare with a Medigap plan offers more predictable total costs for people with significant health needs. Compare total annual costs (premiums + expected out-of-pocket) rather than just monthly premiums.

Can I Have Both Medicare Advantage and Original Medicare?

No. When you enroll in a Medicare Advantage plan, your benefits are provided through that plan rather than through Original Medicare. You're still technically enrolled in Part A and Part B, but the Advantage plan pays your claims instead of Medicare.

If I Switch from Medicare Advantage to Original Medicare, Can I Get a Medigap Plan?

Possibly, but it may be difficult. Outside of guaranteed issue periods, Medigap insurers can use medical underwriting in most states. If you have pre-existing conditions, you may be denied or charged higher premiums. This is why many advisors recommend carefully considering the Medigap vs. Medicare Advantage decision at age 65, when you have guaranteed issue rights.