Medicare Advantage vs. Original Medicare in 2026: A Side-by-Side Comparison

Choosing between Original Medicare and Medicare Advantage is one of the most important health care decisions you can make. About 33 million Americans are now enrolled in Medicare Advantage plans, nearly half of all Medicare beneficiaries. But that does not mean it is the right choice for everyone.

Both options have real strengths and real weaknesses. The best choice depends on your health, your budget, where you live, and how you prefer to receive care. This guide breaks down both options side by side so you can make an informed decision.

The Basics: How They Work

Original Medicare is the federal program that has been around since 1965. It has two parts:

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Most people pay no premium for Part A.
Part B covers doctor visits, outpatient care, preventive services, and medical equipment. The standard Part B premium in 2026 is $185 per month.

With Original Medicare, you can see any doctor or hospital in the country that accepts Medicare. No referrals needed. No network restrictions.

Medicare Advantage (Part C) is an alternative to Original Medicare. These are private health plans, run by insurance companies like UnitedHealthcare, Humana, Aetna, and Blue Cross, that contract with Medicare to provide your Part A and Part B benefits. Most Medicare Advantage plans also include Part D (prescription drugs) and extras like dental, vision, and hearing coverage.

Medicare Advantage plans use networks. You typically must use doctors and hospitals within the plan’s network, except in emergencies.

Side-by-Side Comparison

Feature	Original Medicare	Medicare Advantage
Monthly premium	Part B: $185/month (2026). Part A: $0 for most people	Part B premium still applies. Plan premium: often $0 to $50/month additional
Doctor choice	Any doctor who accepts Medicare, anywhere in the U.S.	Must use plan’s network (HMO) or pay more for out-of-network (PPO)
Referrals needed?	No	Often yes, especially with HMO plans
Out-of-pocket maximum	No cap (unlimited)	Capped. Federal maximum is $8,850 in 2026 for in-network services
Prescription drugs	Must buy a separate Part D plan	Usually included in the plan
Dental, vision, hearing	Not covered (except limited cases)	Often included at no extra cost
Supplemental insurance	Can buy Medigap to cover gaps	Cannot buy Medigap while enrolled in Medicare Advantage
Travel coverage	Works anywhere in the U.S. Limited foreign coverage	Network-based. May not cover care outside your service area

The Case for Original Medicare

Original Medicare makes the most sense in certain situations:

You want maximum doctor choice. Original Medicare works with any doctor, specialist, or hospital that accepts Medicare. That is about 97% of physicians nationwide. You can see a specialist without a referral. You can get care in any state without worrying about networks.

You travel often or split time between states. If you spend winters in Florida and summers in Michigan, Original Medicare covers you in both places without any hassle. Medicare Advantage networks are local, so your plan in Michigan may not cover doctors in Florida (except for emergencies).

You have complex health needs. If you see multiple specialists or need care at a specific medical center (like the Mayo Clinic or MD Anderson), Original Medicare gives you that freedom. Some top specialists and hospitals do not participate in Medicare Advantage networks.

You want predictable costs. When you pair Original Medicare with a Medigap supplemental insurance policy, your out-of-pocket costs become very predictable. The most popular Medigap plan (Plan G) covers nearly all of Original Medicare’s gaps, including the 20% coinsurance for Part B services. You pay the Part B deductible ($257 in 2026), and Medigap covers the rest.

The downside of Original Medicare: Without Medigap, your costs are unpredictable because there is no out-of-pocket maximum. A long hospital stay or major surgery could leave you with large bills. Medigap premiums range from $100 to $300 per month depending on your location, age, and the plan you choose.

The Case for Medicare Advantage

Medicare Advantage can be a good choice in different circumstances:

You want low premiums. Many Medicare Advantage plans charge $0 in monthly premiums beyond the Part B premium. This is appealing if you are on a tight budget and healthy.

You want dental, vision, and hearing coverage. Original Medicare does not cover routine dental care, eyeglasses, or hearing aids (outside the new hearing aid benefit for moderate to severe loss). Many Medicare Advantage plans include these at no extra cost.

You want prescription drug coverage bundled in. Most Medicare Advantage plans include Part D drug coverage. With Original Medicare, you must shop for and enroll in a separate Part D plan.

You want an out-of-pocket cap. Medicare Advantage plans have a yearly limit on what you pay out of pocket for in-network services. In 2026, the federal maximum is $8,850, though many plans set their caps lower. Original Medicare has no cap at all unless you buy Medigap.

You prefer managed care. Some people like having a primary care doctor who coordinates their care and makes referrals to specialists. HMO-style Medicare Advantage plans work this way. It can simplify things if you do not want to manage your own care decisions.

The downside of Medicare Advantage: Networks limit your choices. If your favorite doctor is not in the network, you either pay full price or switch doctors. Prior authorization requirements can delay or deny care. And if your health needs change, switching back to Original Medicare after age 65 may require medical underwriting for Medigap in most states, meaning you could be charged more or denied coverage based on pre-existing conditions.

The Prior Authorization Problem

One of the biggest complaints about Medicare Advantage is prior authorization. This is when your plan requires approval before you can get a test, procedure, or medication. The plan reviews whether the service is “medically necessary” before agreeing to pay.

A 2024 report from the U.S. Department of Health and Human Services found that Medicare Advantage plans denied 18% of prior authorization requests. Of those denials, about 75% were later overturned on appeal, suggesting many were denied incorrectly.

Prior authorization can delay care by days or weeks. For routine tests, this may be a minor annoyance. For urgent treatment, it can be a serious problem.

In 2024, CMS finalized new rules requiring Medicare Advantage plans to speed up prior authorization decisions and reduce unnecessary denials. These rules are phasing in through 2026. The situation is improving, but prior authorization remains a real concern.

How to Decide: Key Questions

Ask yourself these questions:

Do I have doctors I want to keep? Check whether they participate in the Medicare Advantage plans available in your area. If they do not, Original Medicare may be the better choice.
Do I travel or live in more than one state? If yes, Original Medicare’s nationwide coverage is a major advantage.
Can I afford Medigap? If you choose Original Medicare, a Medigap policy fills in the gaps but adds $100 to $300 per month. If that fits your budget, Original Medicare plus Medigap often provides the most complete coverage.
Do I need dental, vision, or hearing coverage? If these matter to you and you do not want to buy separate policies, Medicare Advantage bundles them in.
Am I comfortable with network restrictions? If you are okay seeing in-network doctors and getting referrals, a Medicare Advantage plan can work well and save money.
How is my health right now? If you are healthy, a low-cost Medicare Advantage plan may be fine. If you have serious or complex conditions, the flexibility of Original Medicare may serve you better.

What About Switching Later?

You can switch between Original Medicare and Medicare Advantage during the Annual Enrollment Period (October 15 to December 7 each year). But there is an important catch:

If you drop your Medigap policy to join Medicare Advantage, you may not be able to get Medigap back at the same price (or at all) if you later switch back to Original Medicare. In most states, Medigap insurers can deny coverage or charge higher premiums based on your health once your initial enrollment period has passed.

A few states (Connecticut, Maine, Massachusetts, New York) have guaranteed-issue protections that let you buy Medigap at any time regardless of health. But in most states, once you leave Medigap, the door may close.

This is one of the most important things to understand before making your choice. Think carefully before giving up a Medigap policy.

Getting Free, Unbiased Help

SHIP (State Health Insurance Assistance Program): Free counseling in every state. Call 1-877-839-2675.
Medicare.gov Plan Finder: Compare plans in your area at medicare.gov.
1-800-MEDICARE (1-800-633-4227): 24/7 help line.
Your local Area Agency on Aging: Find yours at eldercare.acl.gov or call 1-800-677-1116.

These resources are free and do not sell insurance. Agents and brokers who sell Medicare plans earn commissions, which can influence their recommendations. Always get a second opinion from an independent source.

Reported by Margaret Chen with additional research from the SeniorDaily editorial team. For corrections or updates, please contact us.