📋 Facts sourced from Medicare & You 2026, the official U.S. government Medicare handbook.

The Official Comparison Table

The table below is drawn directly from the comparison Medicare publishes in its official handbook, with plain-English explanations added for each category.

Category Original Medicare (A + B) Medicare Advantage (Part C)
Doctor & hospital choice Any doctor or hospital that accepts Medicare, anywhere in the U.S. Must generally use providers in the plan's network and service area for non-emergency care. Some plans cover out-of-network at higher cost.
Specialist referrals No referral needed in most cases to see a specialist. You may need a referral (especially in HMO plans) to see a specialist.
Monthly premium You pay the Part B premium ($202.90/month in 2026). If you add Part D, you pay a separate drug plan premium. You still pay Part B premium, plus a plan premium (often $0). Most plans include drug coverage, so no separate Part D premium.
Cost-sharing 20% coinsurance after your Part B deductible ($283/year in 2026) for most services. Varies by plan — may use copays, coinsurance, or both. Plans set their own cost-sharing structure within Medicare's rules.
Out-of-pocket maximum No yearly cap unless you add supplemental coverage (Medigap, employer, Medicaid). Required yearly out-of-pocket maximum. Once you hit it, covered services are free for the rest of the year.
Medigap supplement You can purchase Medigap to cover your 20% coinsurance and other cost-sharing. You cannot buy Medigap while enrolled in Medicare Advantage.
Drug coverage Must join a separate Part D plan to get drug coverage. Most plans include Part D — no separate plan needed.
Prior authorization Generally not required. If Medicare covers it and your doctor orders it, Medicare pays. Plans may require prior authorization before covering certain services or medications.
Extra benefits Does not cover routine dental, vision, hearing aids, or fitness benefits. May offer dental, vision, hearing, fitness, OTC allowances, and more — varies by plan.
Coverage outside the U.S. Generally not covered. Medigap can add foreign travel emergency coverage. Generally not covered. Some plans offer emergency/urgently needed care abroad as an extra benefit.
Hospice care Covered under Original Medicare — billed to Medicare. Hospice is still billed to Original Medicare even if you're in a Medicare Advantage Plan.

The Critical Point About Medigap

One of the most important long-term consequences of choosing Medicare Advantage is what it means for your future Medigap options. When you first enroll in Medicare Part B, you have a 6-month Medigap Open Enrollment Period during which insurers must sell you any Medigap plan they offer — at standard rates, regardless of your health. After that window closes, Medigap insurers in most states can use medical underwriting to deny coverage or charge higher rates based on your health history.

If you enroll in Medicare Advantage instead and later want to switch to Original Medicare (with a Medigap supplement), you may find that you can't get affordable Medigap coverage — or any coverage at all — if your health has changed. This is the trade-off that often isn't mentioned in Medicare Advantage marketing.

Once your Medigap open enrollment window closes, it rarely reopens

A few states (including Massachusetts, New York, and Connecticut) have more favorable Medigap rules that provide more protections. But in most states, the moment you leave your initial Part B enrollment period, your Medigap rights become limited. Choosing Medicare Advantage at 65 could mean paying much more for Original Medicare + Medigap if you want to switch at 75 after a serious health event.

Who Fits Which Path

Original Medicare (+ Medigap + Part D) tends to fit people who:

  • Want to see any doctor, anywhere, with no referrals
  • Travel frequently between states or internationally
  • Have complex conditions and multiple specialists
  • Want predictable, capped out-of-pocket costs via Medigap
  • Prefer to avoid prior authorization and plan networks
  • Can afford the Medigap premium alongside Part B

Medicare Advantage tends to fit people who:

  • Are generally healthy and use health care infrequently
  • Want dental, vision, or hearing benefits bundled in
  • Live in one area and have local primary care relationships
  • Want a $0 plan premium to minimize fixed monthly costs
  • Qualify for a Dual Eligible or Special Needs Plan
  • Prefer the structure of a managed care network
Neither is universally better — it genuinely depends on your situation

Betsy works with clients in both paths. The right answer depends on your health, your doctors, your drugs, your budget, where you live and travel, and your risk tolerance. A healthy 65-year-old and a 75-year-old managing three chronic conditions should not be making the same choice — even if they live in the same zip code.

💬
Betsy's Take

"The comparison table is a starting point. What it can't show you is what the plans actually look like in your county, whether your specific doctors are in-network, whether your prescriptions are on the formulary, and what the real out-of-pocket exposure looks like based on your health history. That's what I do. I run the numbers for your specific situation — and I give you an honest answer, not a pitch."

Talk to Betsy — Free Consultation