By Naomi Foster, Contributing Writer, HealthcareUpdated July 2, 2026
Estimate your real Medicare Advantage cost.
Run your own premiums and copays through the calculator and see the gap.
Open the calculatorMedicare Advantage (Part C) and Original Medicare each suit different needs, depending on your health use, budget, and how much provider flexibility matters to you. Neither option is always cheaper. Original Medicare has no out-of-pocket cap but lets you see almost any provider nationwide, while Medicare Advantage often has low or zero monthly plan premiums, predictable copays, and an annual out-of-pocket maximum that limits your total exposure.
Details: How Each Option Works
Original Medicare is the federal government's traditional fee-for-service program, run directly by the Centers for Medicare and Medicaid Services (CMS). You see any provider that accepts Medicare, pay a share of each service, and face no annual cap on what you spend out of pocket unless you add a Medigap supplement.
Medicare Advantage plans are offered by private insurers approved by Medicare. They must cover everything Original Medicare covers, and most include prescription drug coverage. In exchange for using a network of providers, many plans charge little or nothing in monthly plan premiums beyond the Part B premium you already owe.
Costs you pay regardless of which path you choose
One fact that surprises many new enrollees: joining a Medicare Advantage plan does not eliminate your Part B premium. In 2026, the standard Part B premium is $202.90 per month, according to CMS's official 2026 cost announcement. That amount is billed on top of any plan premium you pay. Higher-income beneficiaries pay more through the income-related monthly adjustment amount (IRMAA), and that surcharge applies under either option.
Side-by-side cost comparison
| Cost Element | Original Medicare (2026) | Medicare Advantage (2026) |
|---|---|---|
| Monthly plan premium | $0 (Part B premium still applies) | Varies; many plans $0, some charge more |
| Part B premium | $202.90/month (standard) | $202.90/month (standard, still required) |
| Part A deductible per benefit period | $1,736 | Varies by plan; may be lower |
| Part B deductible | $283/year | Varies; some plans waive it |
| Doctor visits (coinsurance) | 20% after deductible | Fixed copays, often $0-$40 per visit |
| Annual out-of-pocket maximum | No cap (unlimited) | Capped by law; varies by plan |
| Provider network | Any Medicare-accepting provider | In-network required (HMO) or preferred (PPO) |
| Drug coverage | Separate Part D plan needed | Usually bundled (MAPD plans) |
The out-of-pocket cap
The biggest financial advantage Medicare Advantage holds over Original Medicare is the mandatory annual out-of-pocket maximum. Every Medicare Advantage plan must cap your in-network costs each year. Once you reach that cap, the plan pays 100% of covered services for the rest of the year. Original Medicare has no such protection, so a serious illness could cost you tens of thousands of dollars without a Medigap supplement.
The cap amount varies from plan to plan. You can compare specific plan caps using the Medicare Plan Finder at Medicare.gov, and run a personalized cost estimate with the free Medicare Advantage cost calculator.
Who tends to prefer Original Medicare
- People who travel frequently or split time between states, because Original Medicare works at any provider nationwide who accepts Medicare.
- Those with established relationships with specialists they want to keep, regardless of network membership.
- People who pair Medicare with a Medigap policy to fill cost-sharing gaps and get predictable expenses.
- Those who prefer dealing with Medicare directly rather than through a private insurer.
Who tends to prefer Medicare Advantage
- People who stay mostly within a local area and are comfortable with a provider network.
- Those who want extra benefits such as vision, dental, or hearing coverage, which Original Medicare generally does not include.
- People with limited budgets who benefit from a $0 or low-premium plan with drug coverage bundled in.
- Those who want the financial protection of an annual out-of-pocket maximum without the added cost of a Medigap policy.
Things to Know: Costs to Watch For
Medicare Advantage plans with $0 premiums can still produce meaningful out-of-pocket spending through copays and coinsurance, particularly for specialist visits, procedures, or hospital stays. Read the plan's Summary of Benefits carefully. On the Original Medicare side, the 20% coinsurance on Part B services has no cap, so a costly procedure can turn into a large bill. Compare total expected costs, not just monthly premiums, when weighing your options.
Medigap and the Original Medicare option
If you choose Original Medicare, it helps to understand the role of Medicare Supplement Insurance, commonly called Medigap. These policies are sold by private insurers and cover gaps in Original Medicare cost-sharing, such as the 20% Part B coinsurance and the Part A hospital deductible. A Medigap policy can make your out-of-pocket spending under Original Medicare much more predictable, working somewhat like the out-of-pocket cap in Medicare Advantage.
Medigap comes at an additional monthly premium on top of your Part B premium, and premiums vary by plan type, insurer, and location. The best time to buy is during your six-month Medigap Open Enrollment Period, which begins the month you are 65 or older and enrolled in Part B. During that window, insurers cannot charge you more or deny coverage because of pre-existing conditions. After the window closes, most states allow medical underwriting, so insurers can charge more or decline to cover you based on your health history.
Verify specific plan details at Medicare.gov, and consider speaking with a State Health Insurance Assistance Program (SHIP) counselor, who provides free, unbiased guidance in every state.