Medicare Advantage vs Original Medicare Calculator

Medicare Advantage (Part C) bundles Parts A+B+D through private insurers with lower premium but network restrictions. Original Medicare + Medigap supplement gives nationwide flexibility at higher premium. The right choice depends on health, geography, and tolerance for prior authorization.

MA Plan Mechanics

HMO/PPO style with in-network providers, copays per visit, prior authorization on many services. Includes Part D drug coverage in most plans. Out-of-pocket max: $9,350 in-network 2026, $14,000 combined. Many MA plans charge $0 premium but require Part B premium ($185+/mo).

Medigap Plans (Letter Plans)

Medigap Plan G is most popular post-2020 — covers Part A deductible, Part B coinsurance, skilled nursing co-insurance, excess charges. Plan N is cheaper alternative with small copays. Plan F (most comprehensive) closed to new enrollees 2020+. Open enrollment 6-month window after Part B start gives guaranteed-issue access.

Network and Referral Flexibility

Original Medicare + Medigap: ANY Medicare-accepting provider nationwide, no referrals, no prior auth (Medicare pays first, Medigap covers gaps). MA: must use plan network, often need PCP referral for specialists, prior auth for high-cost procedures. Critical for snowbirds and frequent travelers.

Switching Limits

Open enrollment Oct 15 - Dec 7 each year to switch plans. Medicare Advantage Open Enrollment Jan 1 - Mar 31 allows one switch back to Original. BUT: returning to Medigap after MA may require medical underwriting outside guaranteed-issue windows — can be denied for preexisting conditions in many states.

Last updated May 2026. Sources: Medicare.gov, CMS Medicare.