Medicare Advantage vs Original Calculator

Depends on health, finances, and travel. Medicare Advantage (MA) often has $0-$50 monthly premiums and extra benefits (dental, vision, hearing, fitness) but uses HMO/PPO networks and prior authorization. Original Medicare + Medigap Plan G + Part D averages $250-$400/month combined but accepts any provider nationwide with no prior auth. Light-utilizers and frequent travelers often prefer Original + Medigap; healthy seniors who stay local often prefer MA.

Medicare Advantage plans must cap in-network out-of-pocket spending. For 2026 the federal max is around $9,350 in-network (and $14,000 combined in/out-of-network for PPOs). Once you hit that cap, the plan pays 100%. Original Medicare has NO out-of-pocket cap - a single severe illness could mean unlimited 20% coinsurance, which is why Medigap supplements exist.

Yes - during the Medicare Advantage Open Enrollment Period (Jan 1 - Mar 31) or Annual Enrollment (Oct 15 - Dec 7). But here's the catch: switching back to Original Medicare does NOT guarantee Medigap acceptance. Outside your initial 6-month Medigap open enrollment period after first enrolling in Part B, insurers can deny coverage or charge more based on health. Trial right exception: switching in your first 12 months of MA preserves Medigap rights.

CMS rates MA plans 1-5 stars based on customer satisfaction, prevention, chronic care management, customer service, and operations. 4+ star plans get bonus payments funding extra benefits. Star ratings affect your enrollment timing: 5-star plans accept enrollment year-round via Special Enrollment Period. Plans rated below 3 stars three years running face termination - automatic re-enrollment doesn't happen.