Medicare Advantage vs Original Medicare 2026: Which Should You Choose?

Are you confused about Medicare? Don’t understand the difference between Medicare Advantage Plans and Medicare Part A and Part B? You are not alone. Many of our clients and their caregivers come to us for help.

Should you choose Original Medicare (Parts A and B)? Or should you choose a Medicare Advantage plan (Part C)? What is Medicare Part D?

The good news? There’s no one “right” answer. The right answer depends on your health, your budget, your doctors, and what matters most to you.

We spoke with Dalia Cabrera who has nearly 20 years of Medicare experience to explain the differences and walk you through how to decide which plan is best for you.

What’s the Basic Difference – Medicare Advantage vs. Original Medicare?

Think of it like this:

Original Medicare is run by the government. You can see any doctor in America who takes Medicare. You pay 20% of most medical costs. There’s no yearly limit on what you might spend. If you have a major procedure done, you could pay thousands out of pocket.

Medicare Advantage is run by private insurance companies. You usually need to see doctors in the plan’s network. Usually you pay copays instead of percentages. There’s a yearly limit on what you can spend. You often get extra benefits like dental and vision.

Both options have trade-offs. Let’s look at what you’re actually choosing between.

Original Medicare: Freedom and Flexibility

What You Get

Go anywhere: You can see any doctor, anywhere in the U.S., as long as they take Medicare. Most doctors do.

No referrals needed: Want to see a specialist? Just make an appointment. You don’t need permission from your plan.

No networks: You’re never “out of network.” If a doctor takes Medicare, they take your insurance. If you live in an area with limited providers and have a complex illness and need to go somewhere else for treatment, Original Medicare provides the flexibility to go anywhere.

Coverage everywhere: Traveling? Living part of the year in another state? You’re covered wherever you go in the United States.

The True Costs

You’ll pay:

• Part B premium: $206.50/month in 2026
• Deductibles: $1,676 for hospital stays in 2025 (2026 has not been released yet), $288 for medical care
• 20% of everything covered by Part B after the deductible. These services are things outside of the hospital, like doctor visits, tests, etc.
• No cap: There’s no yearly limit on what you could spend so it could be thousands if you have an expensive procedure.

Real example: If you need a $50,000 surgery, you pay $10,000. If you need cancer treatment costing $200,000, you pay $40,000.

What’s NOT Covered

Original Medicare doesn’t cover:

• Dental care
• Vision care
• Hearing aids
• Most prescriptions (you need to purchase Medicare Part D for prescriptions separately)
• Long-term care (assisted living, nursing homes, dementia care)

Medicare Advantage: All-in-One Simplicity

What You Get

Inclusive Plan: Medicare Advantage plans vary, but most offer coverage for medical, prescription drugs, vision, dental and other benefits. You can select the plan with the benefits you need.

Fixed copays: Instead of 20%, you usually pay predetermined co-pay. For example, you might pay $20 for a doctor visit, $300 for an MRI. Check the plan’s specific policies.

Out-of-pocket maximum: Once you hit your plan’s limit (often $3,000-$8,000), you pay nothing for the rest of the year.

Extra benefits: Most plans include dental, vision, hearing, and gym memberships.

The Trade-offs

Networks matter: You usually need to stay in-network or pay much more. Be sure to check your doctors and preferred hospitals are in network for your plan.

Prior authorization: Some plans, especially HMOs, may require a referral from your doctor to see a specialist or pre-authorization from the plan for treatment before you get them.

Changing doctors: If your doctor leaves the network, you might need to switch or pay a higher coinsurance. Or if you need a specialist only available at a major medical center, they may not be covered.

Geographic limits: Most plans work best in your local area. If you travel to two different regions, there may not be doctors in network at the second location.

The Costs

We can’t give you the costs of Medicare Advantage because it varies widely by plan. However, there are Medicare Advantage plans with no or very low premiums. You still pay your Part B  premium out of your social security, though.

Most also have a cap on yearly spending.

6 Questions to Help You Decide if Medicare Advantage or Original Medicare are Best for You

Question 1: Do You Have Doctors You Love?

If yes → Check if they’re in the Medicare Advantage network

Many doctors take Original Medicare. Fewer take specific Medicare Advantage plans. If keeping your doctors matters, Original Medicare gives you more options.

If you’re flexible → Medicare Advantage could save you money

If you’re okay finding new doctors in the network, Medicare Advantage could save you money.

Question 2: How’s Your Health?

If you’re fairly healthy → Medicare Advantage often costs less

You’ll pay lower premiums. Your copays are predictable. You probably won’t hit the out-of-pocket maximum.

If you have complex health needs → Original Medicare + Medigap might be worth it

You see specialists often. You might need expensive care. The freedom to see anyone and the protection from unlimited costs might matter more than saving money on premiums.

Question 3: Do You Travel or Live in Multiple States?

If yes → Original Medicare is much easier

Your coverage works the same everywhere. No network problems. No worrying about which doctors are “in network.”

If no → Medicare Advantage is fine

If you stay in one area, having a local network isn’t usually a problem.

Question 4: How Much Can You Afford Each Month?

If money is tight → Medicare Advantage premiums are often lower

You might pay $206.50 (just Part B) versus $400+ for Original Medicare + Medigap + Part D.

If you can afford higher premiums → Original Medicare + Medigap gives you more protection

You pay more every month. But you’re protected from big surprise costs.

Question 5: Do You Value Those Extra Benefits offered by Medicare Advantage Plans?

If yes → Medicare Advantage is the only way to get them

Dental cleanings, vision exams, hearing aids, gym memberships—these aren’t covered by Original Medicare at all.

If no → You’re paying for benefits you don’t use

Don’t choose a plan just because it has benefits you’ll never use.

Question 6: How Do You Feel About Getting Approval for Care?

If you want to avoid hassles → Original Medicare is simpler

No prior authorization. No network restrictions. Just get the care your doctor recommends.

If you’re okay with some paperwork → Medicare Advantage can work

Most routine care doesn’t need approval. But some tests, procedures, and medications do.

The Bottom Line

There’s no perfect Medicare choice. There’s only the right choice for YOUR situation.

Choose Original Medicare if:

• You want complete freedom to see any doctor
• You travel frequently or live in multiple states
• You can afford Medigap and Part D premiums for protection
• You have complex health needs

Choose Medicare Advantage if:

• You want lower monthly premiums
• You like having everything in one plan
• You’re comfortable with networks
• You want dental, vision, and hearing coverage

Remember: You can change your mind during next year’s Open Enrollment. But some choices—like getting Medigap later—might be harder or more expensive.

If you need help navigating the choices, our patient advocates can help. Call us at 332-699-6778 or Request Help.