Compare costs and benefits of Medicare Advantage against Original Medicare with Medigap. Get a personalized recommendation based on your health needs and preferences.
This is the most important Medicare decision most seniors will make. Original Medicare (Parts A and B) gives you a government-issued insurance card accepted by nearly every doctor and hospital in the country. Medicare Advantage plans are private insurance alternatives approved by Medicare — they must cover everything Original Medicare covers, but they do so through their own network and rules.
The financial comparison in 2026: Original Medicare with Plan G Medigap and Part D averages around $406/month in total premiums. Medicare Advantage averages $17/month (plus your $185 Part B premium, which you pay regardless of which option you choose). That's a potential premium savings of $200+/month with MA — but the trade-off includes network restrictions, prior authorization requirements for many services, and potentially higher out-of-pocket costs if you need significant care.
Important 2026 update: All Medicare Advantage plans are now required to have an annual out-of-pocket maximum of no more than $9,350 for in-network services (up to $14,000 combined in-network and out-of-network). This provides significant protection against catastrophic costs — but Original Medicare with Medigap provides comparable protection through Medigap coverage that pays the 20% coinsurance, with no annual cap needed.
Helen is 65, in good health, sees her primary care doctor about 6 times per year, takes 2 generic prescriptions, and has a specialist she'd like to continue seeing. Her income is $80,000/year (no IRMAA).
Original Medicare + Plan G
Medicare Advantage (avg)
Helen saves $204.50/month ($2,454/year) with MA premiums. However, she must verify her specialist is in the MA plan's network. If she has a major hospitalization, she'll have copays under MA. For a healthy 65-year-old flexible about providers, MA can make financial sense. But with a valued specialist, Helen should carefully check network before enrolling. A licensed Medicare advisor can compare specific plans available in her area.
Doctor and Hospital Networks
Original Medicare is accepted by virtually every doctor and hospital in the US (approximately 93% of physicians accept Medicare). Medicare Advantage plans use networks — HMOs restrict you to network providers, while PPOs allow out-of-network visits at higher cost. If you have established relationships with specific specialists or prefer a particular hospital system, verify they are in-network before choosing an MA plan. Networks can also change year to year — a doctor in-network this year may drop out next year.
Prior Authorization Requirements
Medicare Advantage plans can require prior authorization — advance approval from the insurance company — for many services, including surgeries, hospitalizations, specialist referrals, and durable medical equipment. Original Medicare with Medigap has no prior authorization requirements. Under new 2024 CMS rules, MA plans must respond to prior authorization requests within 72 hours (urgent) or 7 days (standard). Denial of necessary care is a significant concern — you can appeal, but the process takes time during a health crisis.
Total Cost of Care vs. Premium Savings
Lower MA premiums can be offset by higher cost sharing when you actually need care. With MA, you typically pay copays for every doctor visit ($0–$30), specialist visit ($30–$50), and hospital day (copay per day vs. deductible under Original Medicare). If you have a major health event — hospitalization, surgery, or chronic illness management — your total out-of-pocket costs under MA may rival or exceed what you would pay under Original Medicare with Plan G, which covers 20% coinsurance and the Part A deductible.
Licensed Medicare advisors help you compare Advantage, Supplement, and Part D plans in your area. Free service, no obligation. Compare plans and find coverage that fits your needs and budget.
→ Compare Plans FreeWe may be compensated when you connect with Medicare plan providers through this site. Medicare has neither reviewed nor endorsed this information.
Original Medicare (Parts A and B) is administered directly by the federal government. It lets you see any doctor or hospital that accepts Medicare nationwide — there are no networks. You typically add a Part D drug plan and a Medigap supplement for comprehensive coverage. Medicare Advantage (Part C) is private insurance that bundles Parts A, B, and usually D into one plan. MA plans typically have lower monthly premiums but use provider networks, often require referrals and prior authorization, and have annual out-of-pocket maximums. Original Medicare offers more flexibility; Medicare Advantage offers lower premiums and extra benefits.
Yes. The Annual Enrollment Period (October 15 – December 7) allows you to switch between Original Medicare and Medicare Advantage, or change Medicare Advantage plans. Coverage changes take effect January 1. There is also a Medicare Advantage Open Enrollment Period (January 1 – March 31) that allows you to switch from an MA plan to Original Medicare or to a different MA plan. If you switch from MA back to Original Medicare, buying a Medigap supplement can be difficult — in most states, insurers can use medical underwriting outside your initial enrollment period, potentially denying coverage based on health conditions.
Most Medicare Advantage plans include extra benefits that Original Medicare does not cover. Commonly included extras: preventive dental care (cleanings and exams), vision care (eye exams and glasses/contacts allowance), hearing benefits (hearing exams and aid allowances), fitness memberships (like SilverSneakers), and over-the-counter product allowances. The extent of these benefits varies significantly by plan and insurer. Some plans include comprehensive dental while others cover only preventive care. Compare specific plan benefits at medicare.gov during enrollment periods or contact a licensed Medicare advisor for plan-specific information.
A Medicare Advantage network is the group of doctors, hospitals, and other healthcare providers that have contracted with the insurance company. HMO (Health Maintenance Organization) plans require you to use network providers for all care except emergencies, and usually require a primary care physician referral to see specialists. PPO (Preferred Provider Organization) plans let you see out-of-network providers but at higher cost sharing. PFFS (Private Fee for Service) plans let you see any Medicare-participating provider who accepts the plan's terms. If you have existing specialist relationships or a preferred hospital, verify network inclusion before joining an MA plan.
The best Medicare plan depends on your individual health needs, finances, and preferences. Original Medicare with Medigap (Plan G) is typically better if: you have complex medical needs requiring specialists, you travel frequently and need nationwide coverage, you want predictable costs with no prior authorization, or you want the freedom to see any Medicare-accepting doctor. Medicare Advantage may be better if: you are in good health, you are comfortable with a provider network, you want lower monthly premiums, or you want extra benefits like dental, vision, and hearing. Use our calculator above to compare costs for your specific situation, then consult a licensed Medicare advisor to compare specific plans available in your area.
Medicare Disclaimer
These calculators provide estimates based on 2026 Medicare data for educational purposes only. Contact Medicare at 1-800-MEDICARE or medicare.gov for official plan comparison. Consult a licensed Medicare advisor for personalized plan guidance. Not affiliated with Medicare or the US government.
Medicare Advantage plan availability, premiums, and extra benefits vary significantly by state. Select your state for local Medicare Advantage plan counts and average premiums.