Quick Answer: Medicare Advantage (Part C) replaces Original Medicare through a private insurer and usually adds dental, vision, and drug coverage. The 2026 statutory MOOP cap is $9,250; the average in-network maximum is $6,073. Original Medicare covers any Medicare-accepting provider but has no built-in annual cost cap, so most people add Medigap and a standalone Part D plan. Confirm your Medicare eligibility before enrolling.
Medicare Advantage vs. Original Medicare + Medigap: 2026 Side-by-Side
The core tradeoff: Medicare Advantage offers lower monthly outlay but restricts you to a network and may require referrals in HMO-style plans. Original Medicare + Medigap costs more monthly but covers any Medicare-accepting provider with no referrals. Approaching 65 on marketplace coverage? Review ACA income limits before your Medicare start date. For a direct comparison of what each path covers, see Medigap vs Medicare Advantage and does Medicare cover dental to understand what extras you may need to purchase separately.
Frequently Asked Questions
What is the 2026 out-of-pocket maximum for Medicare Advantage?
The 2026 statutory cap is $9,250 for in-network services; the average plan lands at $6,073, per KFF. After you hit the cap, the plan pays 100% of covered in-network costs.
Can I switch from Medicare Advantage back to Original Medicare?
Yes. The Medicare Advantage Open Enrollment Period runs January 1 to March 31 each year. MA enrollees can switch plans or return to Original Medicare. Returning switchers may face medical underwriting for Medigap in most states, unless they have a guaranteed issue right. For example, if you joined Medicare Advantage when you first got Medicare at 65 and leave within the first year, you can buy any Medigap policy. See medicare.gov for details.
Does Medigap cover prescriptions in 2026?
No. Medigap plans sold after 2005 do not include drug coverage. You need a standalone Part D plan; the 2026 Part D out-of-pocket cap is $2,100. Use the medical bill analyzer to estimate drug costs before enrolling.
