The short answer
People with Medicare choose between two ways to get coverage. Original Medicare, Parts A and B, is run by the federal government: you can see any doctor or hospital in the country that accepts Medicare, usually without prior approval, but after the deductibles you pay 20 percent of most costs with no yearly limit, and drug coverage is a separate Part D plan. Many people add a Medigap policy to fill those gaps. Medicare Advantage, or Part C, is a private plan that covers the same services, usually includes drug coverage and extras such as dental or vision, and caps your yearly out-of-pocket costs, at no more than $9,250 in network in 2026, but uses networks and often requires prior authorization. You still pay the Part B premium, $202.90 a month in 2026, with either choice. You can switch each year from October 15 to December 7, but buying a Medigap policy later can be difficult.
The real choice
Both routes give you Medicare. The difference is how the coverage is organized and paid for. Original Medicare trades a higher and less predictable bill for the freedom to see almost any provider in the country. Medicare Advantage trades that freedom for a network, lower monthly costs in many cases, and a ceiling on how much a bad year can cost.
Neither is better in general. The better choice is the one that fits your doctors, your health and your plans for the next several years, and because switching back is not always as easy as switching in, it is worth getting right the first time. Plans also change their networks and costs every year, so the decision deserves a fresh look each fall.
Side by side
Swipe sideways to see the whole table.
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Who runs it | The federal government | A private company approved by Medicare |
| Doctors and hospitals | Any provider in the U.S. that accepts Medicare | Usually a network; out-of-network care costs more or is not covered |
| Referrals and prior approval | Rarely needed | Often required for specialists and some services |
| Yearly limit on your costs | None, unless you add Medigap | No more than $9,250 in network, or $13,900 combined |
| Drug coverage | A separate Part D plan | Usually included |
| Routine dental, vision, hearing | Not covered | Often included |
| Travel | Works anywhere in the U.S. | Emergencies anywhere; routine care usually local |
With either route you still pay the Part B premium, $202.90 a month in 2026 for most people.
Original Medicare, and why many add Medigap
Original Medicare is Part A, hospital insurance, and Part B, medical insurance. In 2026 you pay a $1,736 deductible for each hospital benefit period and, under Part B, a $283 deductible and then usually 20 percent of the approved amount, with no yearly cap. Drug coverage comes from a stand-alone Part D plan; see Medicare Part D.
That open-ended 20 percent is why many people buy a Medigap policy from a private insurer. Medigap plans are standardized by letter, so a Plan G covers the same benefits whichever company sells it, though prices differ. Medigap works only with Original Medicare, and the best time to buy it is the six months starting when you are 65 and enrolled in Part B, when insurers cannot refuse you or charge more for your health.
Medicare Advantage, and how plans differ
A Medicare Advantage plan must cover everything Original Medicare covers except hospice, which Original Medicare keeps paying for. Most include Part D drug coverage, and many add routine dental, vision and hearing care or fitness programs. Plans come in a few main types:
- HMOs generally require you to use the network and get referrals for specialists.
- PPOs let you go out of network at a higher cost.
- Special Needs Plans serve people with both Medicare and Medicaid, certain chronic conditions, or who live in a nursing home.
Most plans require prior authorization for some services, such as hospital stays, imaging or skilled nursing. You pay the Part B premium plus any plan premium; many charge none, and a few reduce your Part B premium. Copays apply to each service up to the plan's yearly limit, which can be lower than the federal maximum. Part D drug costs, capped separately at $2,100 in 2026, do not count toward it. Medicare rates plans from one to five stars each year, and you can switch into a five-star plan in your area once during most of the year.
Comparing costs the way they actually land
Premiums are the easiest number to compare and the least useful on their own. A fairer comparison adds up three things for each option you are considering:
- A quiet year: all premiums for twelve months, plus the copays or coinsurance for the care you use in a typical year, such as checkups, a few specialist visits and your regular prescriptions.
- A hard year: the most you could pay if you were hospitalized or needed surgery, which for Medicare Advantage is the plan's out-of-pocket limit plus premiums, and for Original Medicare with Medigap is mostly the premiums and the Part B deductible.
- Your drugs: the cost of your actual prescriptions under each plan's drug list, which the plan finder calculates if you enter them.
A plan that wins on a quiet year may lose badly on a hard one, and the reverse. Which matters more depends on your health and on how much financial risk you can carry.
Who each route tends to fit
Two hypothetical retirees, two reasonable choices
Carlos is 65, healthy, takes two generic drugs and sees one doctor in his town, who is in a local HMO's network. He chooses a Medicare Advantage plan with no premium beyond Part B and drug coverage included. His monthly cost is low and his worst year is capped, but he needs referrals and must stay in network.
Joan has a heart condition, sees specialists at a hospital in another state and spends winters away from home. She chooses Original Medicare with a Medigap Plan G and a Part D plan. Her premiums are higher, but any provider that accepts Medicare will see her without a referral, and after the Part B deductible her Medigap plan pays her remaining share of covered costs.
Neither choice is a mistake. Each fits a life. Estimate your Medicare premium at your income, since the income-related amount applies to both routes.
The catch nobody advertises: changing your mind
You can move between the two routes each year from October 15 to December 7, with changes starting January 1. If you are in a Medicare Advantage plan, you also get one change from January 1 to March 31, and special enrollment periods follow events such as moving out of your plan's area or qualifying for Medicaid or Extra Help.
Switching back to Original Medicare is always possible. Getting Medigap back may not be. After your first six-month Medigap window, insurers in most states can ask health questions and refuse you or charge more. There are protections: if you join Medicare Advantage when you first get Medicare and leave within 12 months, or drop a Medigap policy to try Medicare Advantage for the first time and leave within 12 months, you have a right to buy Medigap. A few states give broader rights. Someone in good health at 65 who expects their health to change should weigh this before choosing.
Situations that change the answer
You have Medicare and Medicaid
Full Medicaid usually covers most of Original Medicare's cost-sharing, so a supplement is rarely needed. Dual Eligible Special Needs Plans coordinate the two programs; check the network as carefully as with any plan. Our guide to Medicare and Medicaid explains how the programs fit together.
You have retiree or union coverage
Some former employers provide coverage through their own Medicare Advantage plan or require Original Medicare. Joining a different plan on your own can end your retiree benefits, sometimes for good, and may end a spouse's coverage too. Ask the benefits office first.
You have kidney failure
People with end-stage renal disease can join Medicare Advantage plans, an option since 2021. Check that your dialysis center and transplant hospital are in the network.
Before you choose: what to check
- Whether your doctors, hospitals and pharmacies are in the plan's network, and whether that is likely to change.
- Whether your drugs are on the plan's list, and at what cost tier.
- The yearly out-of-pocket limit and the copays for the care you actually use, not just the premium.
- Which services need prior authorization or referrals.
- Coverage away from home, if you travel or live in two places.
Medicare's plan finder shows next year's plans for your ZIP code, with star ratings, and your State Health Insurance Assistance Program offers free, unbiased counseling. If your income is limited, Medicare Savings Programs and Extra Help can pay premiums under either route.
Common questions
Is Medicare Advantage the same as Medicare?
It is a way to receive your Medicare benefits through a private plan. You are still in Medicare, still pay the Part B premium, and keep the right to return to Original Medicare during enrollment periods.
Does Medicare Advantage have a yearly out-of-pocket limit?
Yes. For 2026 it cannot be more than $9,250 in network, or $13,900 for in-network and out-of-network services combined. Original Medicare has no limit unless you add Medigap.
Can I have Medigap and Medicare Advantage together?
No. Medigap works only with Original Medicare, and it is illegal for an insurer to sell you a Medigap policy if they know you are in a Medicare Advantage plan.
Does Medicare cover care outside the United States?
Original Medicare generally does not. Some Medigap plans pay part of the cost of emergency care abroad, and some Medicare Advantage plans cover emergencies outside the country, so check before you travel.
No plan recommendations here
Plans, networks, premiums and drug lists differ by county and change every year, so this guide compares the two kinds of coverage in general terms. Nobody here sells or recommends Medicare plans. Read your plan's Annual Notice of Change each fall; it lists next year's costs and benefits.
Official sources
When you compare plans this fall
Before October 15, write down your doctors, hospitals and medicines, then compare plans for your ZIP code in Medicare's plan finder against that list. If you are new to Medicare, read when to sign up first, because your first six months decide your Medigap rights.
