Medicare & Insurance

Medicare Advantage or Original Medicare? How to Compare Before December 7

By Lena Ortiz / November 8, 2026

Every fall, people with Medicare can review their coverage and make changes. This year the window runs from October 15 to December 7, 2026. The big choice for many is Original Medicare, run by the federal government, or Medicare Advantage, a plan sold by a private company. This guide explains both, shows how costs work, and offers a step-by-step way to compare. It also covers the January 1 to March 31 window and scams.

Key takeaways

Open Enrollment runs October 15 to December 7, 2026. Changes begin January 1, 2027.
Original Medicare lets you see any doctor that accepts Medicare, but it has no yearly limit on what you pay unless you have other coverage.
Medicare Advantage usually uses a network and may require approval in advance. In 2027 its yearly limit is no more than $9,850 for in-network care.
Medigap works only with Original Medicare and may be hard to buy later.
Medicare will not call to sell you anything. Free help is available from your State Health Insurance Assistance Program (SHIP) at 877-839-2675.

The two options in plain words

Medicare has several parts. Part A is hospital insurance. Part B is medical insurance, such as doctor visits. Together they are Original Medicare. Part D is prescription drug coverage. Medicare Advantage is also called Part C.

Original Medicare

You can see any doctor or hospital in the country that accepts Medicare. You pay a deductible, the amount you pay yourself before Medicare starts to pay, and then your share of each service. You can add a separate drug plan and a Medigap policy.

Medicare Advantage

Private companies approved by Medicare sell these plans. A plan bundles Parts A and B, and most include drug coverage. Plans must cover what Original Medicare covers, and many add vision, hearing or dental care. Most ask you to use doctors in their network.

Question	Original Medicare	Medicare Advantage
Drug coverage	Add a separate Part D plan	Usually included
Choice of doctors	Any that accept Medicare	Generally the plan’s network
Yearly limit on what you pay	None, unless you have other coverage	Yes; 2027 maximum for in-network care is $9,850
Approval in advance	Usually not required	May be required
Medigap	You can buy it	You cannot buy it

What each option costs

A premium is the monthly amount you pay to keep coverage. A copay is a flat fee for a visit. Coinsurance is a percentage of the cost. An out-of-pocket limit is a yearly ceiling on what you pay for covered care.

Original Medicare (2026 amounts)

Part B premium: $202.90 a month, higher for some people with higher incomes.
Part B deductible: $283 a year. After that you generally pay 20% of the Medicare-approved amount.
Part A deductible: $1,736 for each inpatient hospital benefit period.

There is no yearly cap unless you have supplemental coverage, such as Medigap or retiree coverage.

What about 2027?

On November 8, 2026, we could not find official 2027 Part B amounts on Medicare.gov or the CMS website. CMS published the 2026 amounts on November 14, 2025. Check Medicare.gov for the 2027 premium and deductible before you decide.

Medicare Advantage

You still pay the Part B premium. A plan may add its own premium, which can be $0. KFF, a health research group, found that about 75% of people in individual plans with drug coverage paid no plan premium beyond Part B in 2026. Copays and coinsurance vary by plan.

Every plan has a yearly out-of-pocket limit. After you reach it, covered services cost nothing more that year. In 2027, no plan can set it above $9,850 for in-network care, and many set it lower. KFF put the 2026 average in-network limit at $5,421.

Drug plans (Part D)

Drug coverage is optional with Original Medicare. If you go 63 days or more without Part D or other qualifying drug coverage, you may owe a late penalty added to your premium.

For 2027, a Part D deductible cannot be more than $700, up from $615 in 2026. Once your yearly out-of-pocket drug costs reach $2,400 (it was $2,100 in 2026), you pay nothing more for covered drugs that year. Most Medicare Advantage plans include drug coverage.

Doctors, approval in advance and Medigap

Doctors and networks

A network is the group of doctors and hospitals a plan has agreements with. In Medicare Advantage, staying in network usually keeps costs lowest, and out-of-network care may cost more. Emergency and urgent care are covered. Some plans require a referral to see a specialist.

Choices depend on where you live. KFF found the average person has 28 Medicare Advantage plans with drug coverage in 2027, yet 193 counties have none. Do not assume your plan will look the same next year.

Prior authorization

Prior authorization means the plan must approve a service before it pays. Original Medicare usually does not require it. KFF found that in 2026, 99% of people in individual Medicare Advantage plans were in plans that require it for some services, including hospital stays (97%) and medicines covered under Part B (94%). Ask each plan which services need approval.

Medigap: what it is and when you can get it

Medigap, also called Medicare Supplement Insurance, is a private policy that helps pay costs Original Medicare leaves to you, such as the 20% coinsurance. Policies are standardized by letter, so a Plan G has the same benefits from any company, and price is the main difference. It does not usually cover long-term care, vision, dental, hearing aids or drugs.

The best time to buy is the six months after your Part B starts, if you are 65 or older. Then you can buy any policy sold in your state, even with health problems. Later, companies may refuse you or charge more unless you have a “guaranteed issue” right, such as when your plan leaves your area. You usually have 63 days to apply.

If you leave Medicare Advantage later, a company may ask health questions first. KFF notes a “trial right” for people who leave within the first year. A few states, including Connecticut and New York, have more generous rules. Check before you switch.

Key dates and how to compare plans

The enrollment windows

Window	Dates	Who	What you can do
Open Enrollment	October 15 to December 7	Everyone with Medicare	Join, drop or switch a plan, or move between Original Medicare and Medicare Advantage. The plan must get your request by December 7. Starts January 1.
Medicare Advantage Open Enrollment	January 1 to March 31	Only people already in a Medicare Advantage plan	Switch to another Medicare Advantage plan, or return to Original Medicare and join a drug plan. Starts the first of the month after the plan gets your request.
Special Enrollment	Varies	People with a qualifying event	Examples: moving, losing coverage, getting Medicaid or Extra Help.

Your plan sends an Annual Notice of Change, usually in September, explaining what changes in January. Read it first.

A step-by-step method

Gather your Annual Notice of Change, your medicines and doses, and the names of your doctors, hospitals and pharmacy.
Go to Medicare.gov and choose the option to find plans. You can search by ZIP code without logging in.
Enter your medicines, doses and pharmacies. The tool estimates drug costs for each plan.
Compare premiums, deductibles, copays, the out-of-pocket limit and star ratings. Look past the premium.
Check that each doctor and hospital is in the network. Plan Finder has begun listing providers for many plans, but lists can be out of date, so call to confirm.
Ask which services need prior authorization or a referral.
Compare with Original Medicare plus a drug plan and, if you can get one, Medigap.
Talk with a SHIP counselor, then enroll before December 7.

Free help from SHIP

SHIP counselors give free, one-on-one help with enrollment, costs and Medigap. Call 877-839-2675 or find your state program at shiphelp.org. Call early.

Your checklist

I read my 2027 Annual Notice of Change.
I entered every medicine and pharmacy in Plan Finder.
I confirmed each doctor and hospital is in the network.
I compared total costs, not only the premium.
If I might leave Medicare Advantage, I asked about Medigap first.
I spoke with a SHIP counselor and have my confirmation in writing.

Common mistakes and scam warnings

Common mistakes

Choosing by premium alone.
Assuming your plan stays the same. Plans change every year.
Skipping drug coverage and facing a late penalty.

Scam warnings

Medicare will not call, text or email you without warning to ask for your Medicare, bank or card numbers. It will not try to sell you anything. Real Medicare cards are free and arrive by mail.

Caller ID can be faked. Hang up and call 1-800-MEDICARE (1-800-633-4227) yourself.
Nobody can set a deadline other than December 7. Enrolling early earns no extra benefit.
Agents may not offer gifts to enroll or claim Medicare endorses their plan.

Report scams to 1-800-MEDICARE and at ReportFraud.ftc.gov. For suspected fraud, call your Senior Medicare Patrol at 877-808-2468.

Frequently asked questions

What if I miss December 7?

Medicare says you can generally change plans only during set enrollment periods. If you are already in a Medicare Advantage plan, the January 1 to March 31 window may help. A life event may open a Special Enrollment Period.

Is a $0 premium plan really free?

No. You still pay your Part B premium, and you may pay deductibles, copays or coinsurance up to the plan’s limit.

Do I need a separate drug plan?

With Original Medicare, drug coverage is a separate, optional plan, and going without it can bring a late penalty. Most Medicare Advantage plans include it.

Can I buy Medigap later if I leave Medicare Advantage?

It depends on your state, how long you were in the plan and your health. Ask Medigap companies before you switch, and talk with a SHIP counselor.

Before you decide

No option is best for everyone. The right choice depends on your doctors, medicines, budget and location, and plans change every year. Bring your lists to a SHIP counselor, who can look at your own situation, and finish before December 7.