Your Medicare Options, Compared
Original Medicare, Medicare Advantage, and Medicare + Medigap all cover you — but they work very differently. Here’s how they stack up.
Three Paths, Side by Side
| What Matters to You | Original Medicare Alone | Medicare Advantage (Part C) | Original Medicare + Medigap |
|---|---|---|---|
| Type of Coverage | Provided and managed by the federal government | Provided by private carriers contracted with Medicare | Sold by private carriers, standardized and regulated by Medicare |
| Providers & Referrals | Any provider who accepts Medicare, nationwide — no referral needed | Usually a set network; may need a referral to see a specialist | Any provider who accepts Medicare, nationwide — no referral needed |
| What It Covers | Part A (Hospital) & Part B (Medical) | Part C bundles A & B into one plan — replaces Original Medicare | Pays some or all of the costs Original Medicare leaves behind, depending on plan letter* |
| Deductibles (2026) | Part A: $1,736 per benefit period Part B: $283/year |
Varies by carrier — from $0 to separate medical & drug deductibles | N/A on most plans — some high-deductible options require $2,950 out of pocket first** |
| Copays & Coinsurance | 20% coinsurance on most Part B services after deductible | Varies by plan — commonly ~$20/doctor visit, ~$75 ER/urgent care, drug copays by tier | N/A on most plans — Medigap covers some or all of Original Medicare's coinsurance |
| Out-of-Pocket Maximum | None — no annual cap | Every plan must have one; capped at $9,250 in-network for 2026, though many plans set it lower (avg. actual limit ~$5,421)*** | Plan K: $8,000 · Plan L: $4,000 (2026) — most other plans have no real cap since they cover remaining coinsurance |
| Rx, Dental, Vision, Hearing | Not included — needs a separate Part D plan for drugs | Often bundled into the plan, varies by carrier | Not included — needs a separate Part D plan and/or separate ancillary policy |
| Average Premium | Part A: $0 for most · Part B: $202.90/mo (2026 standard rate) | Varies by carrier and plan — often $0 added premium, plus your Part B premium | Varies by age, location, and carrier — plus your Part B premium. We shop multiple carriers to find your best rate. |
| Medical Underwriting | None | Can't be turned down or charged more for a health condition during your Initial or Annual Enrollment window | Guaranteed issue only during your one-time 6-month Medigap Open Enrollment Period or a qualifying Special Enrollment. Outside that window, underwriting applies.**** |
*Also typically covers skilled nursing facility coinsurance and foreign travel emergency care, depending on plan letter. Medigap can't be purchased alongside Medicare Advantage.
**High-deductible Plan F/G option only, where available. Most Medigap plans issued since 2020 don't cover the Part B deductible.
***CMS requires every Medicare Advantage plan to set a maximum, but individual plans often choose limits well below the federal ceiling. Combined in-network + out-of-network limit can run up to $13,900 in 2026 for plans that cover out-of-network care.
****Some states offer additional guaranteed-issue protections beyond the federal minimum — ask us about your state's specific rules.
General comparison for informational purposes — actual plan benefits, networks, and costs vary by carrier and location. Pathway Health Insurance Experts, Inc. specializes in Medicare Supplement (Medigap) plans; we do not sell Medicare Advantage plans. Contact Medicare.gov or 1-800-MEDICARE for a full list of plans available in your area.
Leaning toward Medicare + Medigap?
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