Medicare Advantage vs Original Medicare: Which Costs Less?

Neither one costs less for everybody. Medicare Advantage usually costs less per month, and Original Medicare with a Medigap policy usually costs less in a bad year. Which one costs less for you depends on how much care you use, and that’s the one thing nobody can predict at sign-up time.

That answer frustrates people who want a number. So here are the numbers, where each option’s bill comes from, and where the comparison goes wrong.

The part both options share

Whatever you pick, you pay the Part B premium. In 2026 the standard amount is $202.90 a month, and it’s higher if your income is above a certain level. Medicare Advantage plans don’t replace this bill — you must keep paying Part B to stay in the plan. Some plans offer to pay part of it back, but that’s a plan feature, not a rule.

Most people pay nothing for Part A because they or a spouse paid Medicare taxes long enough while working. That’s true in both options too.

So the real comparison starts after the $202.90. It’s everything you pay beyond that.

What Original Medicare costs when you use it

Original Medicare has no monthly premium beyond Part B for most people. Its costs show up when you get care, and there is no cap on them.

For hospital stays under Part A, you pay a $1,736 deductible for each benefit period in 2026. That covers days 1 through 60. Days 61 through 90 cost $434 a day. Days 91 and beyond cost $868 a day while you use your 60 lifetime reserve days, and after that you pay everything. A benefit period isn’t a calendar year — it starts when you’re admitted and ends after you’ve been out of the hospital or a skilled nursing facility for 60 days in a row. Two separate hospital stays in one year can mean paying the deductible twice.

For doctor visits, outpatient care, and most everything else under Part B, you pay a $283 deductible once a year, then usually 20% of the Medicare-approved amount for each service. There’s no upper limit on that 20%. If you have a $100,000 year of chemotherapy and outpatient surgery, your share can run into five figures.

Skilled nursing facility care after a hospital stay is $0 for days 1 through 20, then $217 a day for days 21 through 100, then everything.

Drug coverage isn’t included. If you want it, you buy a standalone Part D plan with its own premium. In 2026 a Part D plan’s deductible can’t be more than $615, and once your out-of-pocket drug spending reaches $2,100 you pay nothing more for covered drugs the rest of the year.

Where Medigap changes the math

The reason Original Medicare’s open-ended costs don’t scare everyone off is Medigap — Medicare Supplement Insurance sold by private companies to fill those gaps. A Medigap policy charges a monthly premium of its own, and in exchange it pays some or most of the deductibles and coinsurance above.

Which pieces it pays depends on the plan letter. Plan G, for example, covers the Part A deductible and the 20% Part B coinsurance but leaves you the $283 Part B deductible. Plan N covers the same but keeps small copayments for some office and emergency room visits. Plans K and L pay a percentage and cap your spending at $8,000 and $4,000 in 2026 respectively. High-deductible versions of Plans F and G make you pay the first $2,950 in 2026 before they pay anything.

Premiums vary by company, by where you live, by your age, and sometimes by your health. This is the cost the government doesn’t set, so it’s the number you have to shop for yourself.

So the realistic version of “Original Medicare” for most people is: Part B premium + Medigap premium + Part D premium every month, and then very little when you actually get care. High fixed cost, low surprise cost.

What Medicare Advantage costs when you use it

Medicare Advantage bundles Part A and Part B into one private plan, and most plans include drug coverage. Many charge a $0 plan premium beyond Part B. Some charge more. That’s the monthly side.

The care side works like the insurance you probably had at work: copayments and coinsurance set by the plan. A copay for a primary care visit, a different one for a specialist, a per-day amount for the first several days of a hospital stay, a percentage for some outpatient procedures. These amounts vary widely from plan to plan, and they can change every year.

What every Medicare Advantage plan has that Original Medicare lacks is a yearly out-of-pocket limit on Part A and Part B services. Once you reach it, the plan pays 100% of covered services for the rest of the calendar year. Each plan sets its own limit within a ceiling that Medicare sets, and plans with out-of-network coverage may have a separate, higher limit for that care. The limit doesn’t include your premiums, and it doesn’t include drug costs, which have the separate $2,100 cap.

You cannot buy a Medigap policy to cover a Medicare Advantage plan’s copays. Federal law prohibits selling you one unless you’re switching back to Original Medicare.

So the realistic version of “Medicare Advantage” is: Part B premium plus maybe nothing more every month, and then copays as you go, with a ceiling on how bad it can get. Low fixed cost, higher surprise cost, but a known worst case.

Putting the two side by side

The honest reading of this table: a healthy year favors Medicare Advantage, because you paid little and used little. A hard year — a cancer diagnosis, a long hospitalization, a joint replacement with rehab — often favors Original Medicare with Medigap, because your costs were already paid through the premium. Over a decade or more, it can go either way.

What people get wrong

Comparing the premium and stopping there. A $0 premium isn’t a $0 plan. It’s a plan where the cost moved from the premium to the copays. Whether that trade works for you depends entirely on how much care you use.

Forgetting that Original Medicare alone has no cap. People who skip Medigap to save the premium are taking on unlimited risk. That may be a fine choice with good employer or retiree coverage or Medicaid behind it. Without something behind it, one serious illness can cost more than years of Medigap premiums would have.

Assuming you can add Medigap later. Under federal law you get a one-time six-month Medigap Open Enrollment Period, starting the first month you have Part B and are 65 or older. During it, companies must sell you any policy they offer at the same price regardless of your health. After it closes, they can generally ask health questions, charge more, or turn you down, unless you qualify for a specific guaranteed issue right. Someone who picks Medicare Advantage at 65 and wants to switch to Original Medicare with Medigap at 72 may not be able to get the policy they want at a price they can afford. This is the part of the cost comparison that’s about the future rather than this year.

Counting the out-of-pocket limit as a typical cost. It’s a ceiling, not a forecast. Most people never reach it. But it’s the number to look at when asking “what’s the worst year I could have,” and it varies a lot between plans, so it’s worth reading rather than assuming.

Not counting the network. With Original Medicare you can see any doctor or hospital that takes Medicare anywhere in the country. With Medicare Advantage you may need to stay in the plan’s network and get referrals, and out-of-network care can cost more or not be covered at all except in emergencies. That isn’t a dollar figure on a benefits chart, but for people who travel, split time between two states, or see a specialist across a state line, it turns into one.

How to actually run the numbers for yourself

Add up the fixed monthly cost of each option for a year: Part B, plus a Medigap premium quote and a Part D premium on one side, plus a plan premium on the other. Then estimate a normal year of care — your regular prescriptions, your usual doctor visits, any procedure you know is coming — and price it under each option’s copays. Then do the same for a bad year and compare it to the Medicare Advantage plan’s out-of-pocket limit.

Three numbers per option: fixed cost, a normal year, a bad year. That’s the comparison. Anyone who tells you one option always costs less hasn’t done it.

Medicare’s Plan Finder at medicare.gov/plan-compare shows the actual copays, premiums, and out-of-pocket limits for plans in your ZIP code, and can estimate your drug costs if you enter your prescriptions. Your State Health Insurance Assistance Program (SHIP) offers free one-on-one counseling that isn’t tied to any insurance company. And 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day, 7 days a week; TTY users can call 1-877-486-2048.

Sources: CMS.gov, “2026 Medicare Parts A & B Premiums and Deductibles” (cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles); Medicare.gov, “Costs” (medicare.gov/basics/costs/medicare-costs); Medicare.gov, “Compare Original Medicare & Medicare Advantage” (medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage); Medicare.gov, “Compare Medigap Plan Benefits” (medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits); Medicare.gov, “When can I buy a Medigap policy?” (medicare.gov/health-drug-plans/medigap/ready-to-buy/when); Medicare.gov, “Illegal Medigap practices” (medicare.gov/health-drug-plans/medigap/ready-to-buy/how/illegal-practices); CMS.gov, “Final CY 2026 Part D Redesign Program Instructions” (cms.gov/newsroom/fact-sheets/final-cy-2026-part-d-redesign-program-instructions).