Medicare

By the Retiree Report Editorial Team · Updated 2026-04-27 · 7 min read

This article is general information, not medical advice. Talk with a licensed clinician before making any decision about your care.

Medicare Advantage vs Original Medicare in 2026: what really changed

About 35 million older Americans now have a Medicare Advantage plan, and roughly 30 million stick with Original Medicare. The split has been close to half-and-half for a couple of years, but 2026 is the first year a tenth of Advantage members got a letter telling them their plan was going away. That makes the choice between the two routes feel a lot less academic than it used to.

What does each plan actually cost in 2026?

Original Medicare has two parts you pay for separately. Most people get Part A (hospital coverage) without a premium because they paid Medicare taxes for at least 40 quarters. Part B (doctor and outpatient coverage) carries a standard premium of $202.90 a month in 2026, up from $185.00 in 2025, according to the Centers for Medicare & Medicaid Services. Higher earners pay more through the Income-Related Monthly Adjustment Amount, which begins above $109,000 for individuals and $218,000 for couples filing jointly.

Medicare Advantage, also called Part C, bundles A, B, and usually D into a single plan run by a private insurer. You still owe the $202.90 Part B premium, but two-thirds of MA prescription drug plans charge nothing on top of that. KFF reports the average enrollee-weighted premium is about $14 a month, and 98% of beneficiaries can find a $0-premium MA-PD plan in their area. That’s why TV advertising makes Advantage sound free. It isn’t free; the trade-offs show up later.

If you stick with Original Medicare, most people add a standalone Part D drug plan and a Medigap supplement to plug the gaps. Medigap premiums vary widely by state, age, plan letter, and whether the carrier prices by attained age or community rating. Once you stack a Medigap policy and a Part D plan on top of Part B, the typical monthly bill lands well above what a $0-premium Advantage plan looks like on paper. That’s the apples-to-apples comparison most ads skip past.

Who pays more if you actually get sick?

This is where the fine print matters. Original Medicare has no annual out-of-pocket maximum on the medical side. If you’re hospitalized, you pay the Part A deductible of $1,736 per benefit period in 2026, then $434 a day for days 61-90 and $868 a day after that, per CMS. Part B pays 80% of approved doctor charges; you pay the remaining 20%, with no ceiling. A Medigap policy is what turns those open-ended bills into a near-zero number, which is why people with serious chronic illness often prefer the combo.

Medicare Advantage flips the structure. The federal cap on in-network out-of-pocket costs in 2026 is $9,250, and most plans set their cap lower. That ceiling is genuine protection, but it only applies to in-network Part A and Part B services. Out-of-network care, when the plan covers it at all, sits under a separate, higher cap. Prescriptions run on the new Part D out-of-pocket limit, which rose to $2,100 for 2026 — we walked through that change in our explainer on the Part D out-of-pocket cap.

A healthy 67-year-old who travels and rarely sees a doctor often comes out ahead on an Advantage plan. A 78-year-old with diabetes, three specialists, and a recent surgery is usually better off with Medigap, even at twice the monthly cost. The right answer depends on your health, your doctors, and how much risk you’re willing to carry yourself.

Doctor networks, referrals, and prior authorization

Original Medicare lets you see any provider who accepts Medicare, which is the great majority of doctors and nearly every hospital in the country. There’s no referral needed to see a specialist, and there’s no prior authorization for most services. AARP notes that CMS is testing an advance-approval pilot in six states for a narrow set of procedures starting in 2026, but it doesn’t change the basic open-access structure for the rest of the country.

Medicare Advantage works differently. HMO plans, which still account for about 57% of offerings, generally require you to pick a primary care doctor and get referrals before you see a specialist. PPOs, now around 42% of the market, are more flexible but charge more out of network. Prior authorization is the routine friction point: insurers require sign-off before MRIs, certain surgeries, post-acute rehab, and most specialty drugs. Federal rules tightened in 2024 to speed those decisions and require written rationale, but the paperwork hasn’t gone away.

Networks also shrink and re-shuffle every year. If your hospital system drops out of an Advantage plan in October, you can switch during open enrollment, but the providers you trust may not be inside the next plan either. Original Medicare doesn’t have this problem, because it has no network. For people who value calling a specialist directly without an insurer’s blessing, that simplicity is part of what they’re paying for with Medigap.

What to do during open enrollment in 2026

Two windows matter for most people. The Annual Election Period runs October 15 through December 7 and lets anyone change their drug plan, switch from Original Medicare to Advantage, or move between Advantage plans. The Medicare Advantage Open Enrollment Period runs January 1 through March 31 and lets current Advantage members make one change — to a different MA plan or back to Original Medicare. That’s the only routine path back to Original Medicare during the year.

If your plan was one of the 2.6 million terminations tracked by KFF for 2026, you also have a Special Enrollment Period that gives you more time and, in some states, a guaranteed-issue path back into Medigap without medical underwriting. That last detail is the one most people miss. Federal Medigap protections are limited; about half of states layer extra rights on top, including birthday rules in California, Oregon, and now Delaware that let enrollees switch supplements once a year without health questions.

The free tool to use is the official Medicare Plan Finder at medicare.gov, which now shows whether your specific doctors are in a plan’s network. Punch in your medications and ZIP code; the comparison takes about ten minutes once you have your prescription list ready. State Health Insurance Assistance Programs (SHIPs) provide free, unbiased counseling — they don’t sell anything and aren’t tied to any insurer. If your income changed last year, that affects your IRMAA bracket, and we walked through how the 2026 cost-of-living adjustment interacts with the Part B increase in our piece on the real impact of the 2026 COLA. None of this should substitute for a conversation with a licensed broker or, for clinical questions, your own doctor.

What to remember

The choice between Medicare Advantage and Original Medicare comes down to three trade-offs: monthly cost versus catastrophic protection, network restrictions versus open access, and the value of bundled extras like dental, vision, and hearing. Advantage looks cheaper month to month and is, for the average healthy enrollee. Original Medicare paired with Medigap costs more every month but removes the ceiling on serious illness and travels with you anywhere a doctor takes Medicare. The 2026 wave of plan exits is a useful reminder that the Advantage market can change under you, and the route back into a Medigap policy isn’t guaranteed in every state. Plan accordingly, and re-check your decision every fall — you’re allowed to change your mind.