Medicare Advantage vs. Original Medicare: True Annual Cost Comparison — Free
Figures and guidance last verified against official sources in July 2026.
Quick Answer
In 2026, Original Medicare has no annual out-of-pocket maximum. Adding a Medigap Plan G (typically $100-$200/month) covers almost all gaps but adds significant premium cost. Medicare Advantage plans often have $0 premium but can have $3,000-$8,500 out-of-pocket maximums.
Expected Healthcare Usage Inputs (2026 Rules)
Original Medicare + Medigap Plan G
Part B Premium: $2,220/yr ($185/mo)
Plan G Premium: $1,680/yr
Part B Deductible: $257/yr
Estimated Total Annual Out-of-Pocket:$4,157Medicare Advantage (Part C)
Part B Premium: $2,220/yr ($185/mo)
Plan Premium: $0/yr
Estimated Copays: $170/yr
Estimated Total Annual Out-of-Pocket:$2,390Note: Decision-support estimate only. Standalone Part D drug coverage is required for Original Medicare. Always verify local network providers and plan specifics at medicare.gov/plan-compare before enrolling.
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Frequently Asked Questions
What is the main cost difference between Original Medicare and Medicare Advantage?
Original Medicare + Medigap requires higher monthly premiums but provides highly predictable out-of-pocket costs with no network restrictions. Medicare Advantage features low or $0 monthly premiums but uses copays and has out-of-pocket maximum limits.
What does Medigap Plan G cover and how much does it cost in 2026?
Medigap Plan G covers 100% of Part A deductibles, hospital copays, and Part B 20% coinsurance. Enrollees pay only the $257 annual Part B deductible out-of-pocket. Premiums range from $100–$220/month depending on age and state.
Does Medicare Advantage have a maximum out-of-pocket limit in 2026?
Yes. By law, Medicare Advantage plans must cap annual in-network out-of-pocket expenses ($8,850 maximum limit in 2026, though many plans cap lower at $3,500–$6,700).
Does Original Medicare have an annual out-of-pocket maximum?
No. Original Medicare alone has no annual out-of-pocket maximum limit, which is why most beneficiaries purchase a Medigap plan to limit financial risk.
Can I see any doctor with Original Medicare?
Yes. You can see any doctor or specialist in the United States who accepts Medicare, without needing a referral.
What is prior authorization and does it apply to Original Medicare?
Prior authorization requires insurance approval before getting certain procedures or tests. It is widely required in Medicare Advantage, but rarely used in Original Medicare.
When can I switch from Medicare Advantage back to Original Medicare?
You can switch during the Annual Enrollment Period (Oct 15 – Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31). Medical underwriting rules may apply to Medigap when switching.
Does income (IRMAA) affect which plan option makes sense?
IRMAA surcharges apply to Part B and Part D premiums equally regardless of whether you choose Original Medicare or Medicare Advantage.
Other Free Medicare Plan Comparison Tools
Medicare Advantage Plan Comparison Tool →
Compare Medicare Advantage (Part C) plan features, drug coverage, network types, and out-of-pocket maximums.
Medigap Plan Comparison Tool →
Side-by-side comparison of Medigap Plans F, G, and N to find the best value for your health usage.
Medicare Premium Calculator →
Calculate your total combined monthly Medicare cost across Parts A, B, D, Medigap, and any IRMAA surcharges.
About This Educational Estimate: This tool is for educational purposes only. Seniors Audit uses the official formulas published by Centers for Medicare & Medicaid Services (CMS), but results are estimates based on the information you entered. Rules, rates, and eligibility thresholds change annually and vary by individual circumstance.
Always verify your specific result directly with Centers for Medicare & Medicaid Services (CMS) at 1-800-633-4227 or at www.medicare.gov before making enrollment, coverage, or financial decisions.
If you have Medicare questions, a free SHIP counselor in your state can review your specific situation at no cost — find yours at shiphelp.org.
Seniors Audit is independent and not affiliated with any government agency or insurance company. We are not affiliated with, endorsed by, or connected to any government agency, insurance company, or financial services firm. All calculations use the official formulas and current figures published by the agencies listed above. We do not receive payment for referrals, leads, or any action taken by visitors to this site. Last reviewed: July 2026.