4.3 Million Medicare Plans End on December 31: Check Yours Before December 7

4.3 Million Medicare Plans End on December 31: Check Yours Before December 7

Direct answer: A KFF analysis of federal plan data finds that 4.3 million Medicare beneficiaries will have their Medicare Advantage or stand-alone Part D drug plan terminated on December 31, 2026 — 3.1 million in Medicare Advantage drug plans and 1.2 million in stand-alone drug plans. If your plan is ending and you do nothing, you will be moved to Original Medicare, generally without prescription drug coverage. Medicare open enrollment ends December 7, 2026, so check your plan now.

What is happening?

Private insurers change their Medicare offerings every year, but the scale of this year's exits is large. KFF analyzed Centers for Medicare & Medicaid Services (CMS) plan data, based on June 2026 enrollment, and published its findings on October 27, 2026. The terminations include plans that end entirely and plans that stop serving specific counties.

This is a different story from premiums. Earlier this fall we covered the 2027 average Medicare Advantage premium of $12 and the possible Part D average of $51 if enrollees stay put. Those were price stories. This one is about whether your plan exists at all next year — and a low premium means nothing if the plan is gone.

Group	People affected	Share of that group
Medicare Advantage drug plans (MA-PD)	3.1 million	14% of general-enrollment MA-PD enrollees (2.8 million), plus about 300,000 in special needs plans
Stand-alone Part D plans (PDP)	1.2 million	6% of PDP enrollees — double last year's 3%
Plans consolidating, not ending	1.4 million	Moved automatically to another plan from the same insurer

The 1.4 million people in consolidating plans are not losing coverage — their insurer moves them to a different plan. But they should still review the new plan, because costs, benefits, networks, and drug lists can change. The average beneficiary will have 28 Medicare Advantage drug plans and 9 stand-alone drug plans to choose from in 2027; the drug-plan choice count is down from 11 in 2026.

Which insurers are ending the most plans?

Four parent organizations account for half of the people losing an individual Medicare Advantage drug plan:

Insurer	Share of affected MA-PD enrollees	People
Humana	19%	530,000
UnitedHealth Group	13%	367,000
CVS Health	9%	254,000
Aware Integrated (Blue Cross plans in Minnesota)	9%	249,000

On the drug-plan side, the concentration is even sharper: 81% of the 1.2 million people losing a stand-alone Part D plan — about 950,000 people — are in the SilverScript Choice plan sponsored by CVS Health, which is ending in 13 drug-plan regions. Another 190,000 people (16%) are in HealthSpring Extra Rx, ending in 16 regions.

What happens if you do nothing?

If your Medicare Advantage plan ends and you do not choose another plan, you will be switched automatically to Original Medicare (Parts A and B). That switch does not include prescription drug coverage, so you would need to enroll in a stand-alone Part D plan separately if you want drug coverage. Your insurer may instead assign you to another Medicare Advantage plan it offers — check your mail for a notice explaining which outcome applies to you.

There is one protection worth knowing: people whose Medicare Advantage coverage is terminated generally qualify for a special enrollment period for Medigap with guaranteed issue rights, meaning they cannot be denied a Medigap policy or charged more because of a pre-existing condition, according to KFF. The exact window is in your termination notice — ask 1-800-MEDICARE if it is unclear.

Minnesota: the sharpest example

Minnesota shows how concentrated the exits can be. On November 2, 2026, Minnesota Attorney General Keith Ellison warned that nearly 400,000 Minnesotans — nearly one-third of the state's 1.2 million Medicare beneficiaries — will lose their current Medicare Advantage plan for 2027.

In 18 Minnesota counties, there will be no Medicare Advantage coverage in 2027. In 15 of those counties, Medicare Cost plans and Original Medicare remain available. In three counties — Crow Wing, Lake of the Woods, and Wadena — there will be no Medicare Advantage or Medicare Cost plan at all, so Original Medicare is the only option, and residents there must select a Part D drug plan to keep drug coverage. Minnesota Aging Pathways, the state's free counseling service, can be reached at 800-333-2433.

What should you do before December 7?

• Open the Annual Notice of Change letter from your plan. It states whether your plan continues, changes, or ends for 2027.
• Log in at Medicare.gov and use the Plan Finder: enter your prescriptions and your pharmacy to compare the plans available in your county.
• Check three things in any new plan: whether your doctors are in network, whether your prescriptions are covered, and what your total out-of-pocket costs would be.
• If your plan is ending, enroll in a new plan by December 7 so coverage starts January 1, 2027. Call 1-800-MEDICARE (available 24/7) or your state's free SHIP counseling program for help.
• Keep your termination letter. It documents your right to a special enrollment period and to Medigap guaranteed issue rights.

What if you miss December 7?

Missing open enrollment is not the end of the road if your plan is ending. People whose plan is not renewed get a special enrollment period that runs from December 8, 2026 through February 28, 2027. To have new coverage start on January 1 with no gap, enroll by December 31. Enrolling in January means coverage starts February 1, and enrolling in February means it starts March 1 — so December 7 is still the simplest deadline to aim for.

Frequently asked questions

Have I lost Medicare?
No. Your plan is ending, not your Medicare. Your Part A and Part B coverage continues through Original Medicare unless you enroll in a new Medicare Advantage plan.

How do I know if my plan is ending?
Your insurer was required to send an Annual Notice of Change and, if the plan is ending, a non-renewal notice. You can also check your plan's 2027 status by logging in at Medicare.gov.

What is the difference between a terminated plan and a consolidated plan?
A terminated plan ends and you must choose a replacement. A consolidated plan moves you automatically to another plan from the same insurer — about 1.4 million people are in this group — but you should still review the new plan's costs and coverage.

I am in Minnesota. What is different for me?
Nearly 400,000 Minnesotans are affected, and in 18 counties there will be no Medicare Advantage plan in 2027. In Crow Wing, Lake of the Woods, and Wadena counties, Original Medicare is the only option, so a Part D plan is needed for drug coverage. Free help is available from Minnesota Aging Pathways at 800-333-2433.

Can I still buy Medigap if my plan ends?
According to KFF, people whose Medicare Advantage coverage is terminated generally qualify for a special enrollment period for Medigap with guaranteed issue rights. Check the window in your termination notice or call 1-800-MEDICARE.

Where can I verify this myself?
See the KFF analysis, “More Than 4 Million Medicare Beneficiaries Will Have Their Medicare Advantage or Stand-Alone Prescription Drug Plan Terminated at the End of 2026” (October 27, 2026), and the Minnesota Attorney General's November 2, 2026 alert on Medicare Advantage changes.

Key Takeaway

4.3 million Medicare beneficiaries — 3.1 million in Medicare Advantage drug plans and 1.2 million in stand-alone Part D plans — lose their plan on December 31, 2026. If yours is one of them, choose a replacement by December 7 for coverage starting January 1; doing nothing leaves you on Original Medicare without drug coverage.

Sources: KFF, “More Than 4 Million Medicare Beneficiaries Will Have Their Medicare Advantage or Stand-Alone Prescription Drug Plan Terminated at the End of 2026,” October 27, 2026 (analysis of CMS plan data, June 2026 enrollment); Office of Minnesota Attorney General Keith Ellison, press release, November 2, 2026; Medicare.gov special enrollment period rules for non-renewed plans (December 8, 2026 – February 28, 2027).

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This post was created with the help of AI tools and reviewed for accuracy against the sources cited above. It is general information only, not medical advice. For decisions about your own coverage, please talk to a licensed Medicare counselor, your State Health Insurance Assistance Program (SHIP), or 1-800-MEDICARE.

 

Medicare Advantage Premiums in 2027: What the $12 Average Really Means

The headline sounds like a gift: Medicare Advantage premiums are falling to an average of $12 a month in 2027. If your own plan's premium is heading up instead, you might wonder whether you are in the wrong plan — or whether the headline is wrong. Neither is necessarily true. The $12 figure is real, but it is an average, and averages have fine print.

This article unpacks what that average is made of, what it leaves out, and the numbers in your own plan that deserve more attention than the headline. Your premium check for 2027 starts with understanding what "average" actually means.

1. Where the $12 Figure Comes From

On September 28, the Centers for Medicare & Medicaid Services (CMS) projected that the average monthly premium across Medicare Advantage plans will fall from $14.37 in 2026 to about $12 in 2027 — a drop of roughly 16.5 percent. The average is weighted by enrollment, so big plans count more than small ones, and it covers all Medicare Advantage plans, including plans with drug coverage and Special Needs Plans.

One ingredient matters most: a large share of Medicare Advantage plans charge no additional plan premium at all — the premium is $0, on top of the Part B premium everyone pays. All those zeros pull the average down. So the $12 figure does not describe a typical bill so much as a blend: many people paying nothing extra, some paying a little, and some paying considerably more.

2. Why an Average Is Not a Price Tag

CMS also estimates that about 8 in 10 Medicare Advantage members can stay in their current plan for 2027 at the same premium or a lower one. Turn that around: roughly 2 in 10 cannot. Their premiums rise, or their plan leaves their area entirely, even while the national average falls.

Premiums are set plan by plan and county by county. Your premium depends on your plan's costs, your local market, and the benefits your plan chose to fund. A falling national average can comfortably coexist with a rising premium in your mailbox — which is why the only premium that should drive your decision is the 2027 figure printed in your own Annual Notice of Change.

3. What the Premium Never Includes

Even a genuinely lower premium is only one line of your yearly cost. The $12 average says nothing about:

• Your Part B premium, which you continue to pay in almost all cases, with or without a Medicare Advantage plan
• Copays for doctor visits, specialists, hospital stays, and therapy
• The drug deductible and drug copays if your plan includes Part D coverage
• Coinsurance — the percentage of a bill you owe for some services

A plan can trim its premium and quietly recover the money through higher copays elsewhere. The premium is the price of admission; it is not the cost of the year.

4. The Number That Matters More: Your Out-of-Pocket Maximum

Every Medicare Advantage plan has a maximum out-of-pocket limit (MOOP) — the most you can pay in a year for covered in-network medical services. Once you reach it, the plan pays 100 percent of covered in-network care for the rest of the year. Original Medicare has no such cap, which is one of the genuine protections Advantage plans offer.

When you compare plans, put the MOOP next to the premium. A plan charging $0 extra per month but carrying a high out-of-pocket maximum may cost a healthy person nothing and a sick person thousands. A plan with a modest premium and a low maximum can be the cheaper plan in the year you actually need care. Check whether your plan's MOOP is changing for 2027 — it is listed in your Annual Notice of Change, and it moves more quietly than premiums do.

5. Check the Extras Before You Celebrate a Lower Premium

Medicare Advantage plans compete on extras: dental allowances, vision and hearing benefits, over-the-counter cards, and in some plans a Part B giveback that returns part of your Part B premium. These extras are also where plans adjust quietly. A premium can fall while a dental allowance shrinks, an over-the-counter benefit is cut, or a giveback amount drops.

None of that makes a plan bad. It means the honest comparison for 2027 is a short checklist, not a headline:

• Your plan's 2027 premium, from your Annual Notice of Change
• Your plan's 2027 out-of-pocket maximum
• Copays for the doctors and services you actually use
• Your prescriptions, still covered, at workable tiers
• The extras you genuinely use, at their 2027 amounts

The Plan Compare tool at Medicare.gov gathers most of this in one place, and your local SHIP program can walk through it with you for free if the paperwork feels heavy.

Key Takeaway

The projected $12 average Medicare Advantage premium for 2027 is good news about a trend, not a promise about your plan. It blends millions of members, including many who pay no additional premium at all, and it excludes your Part B premium, your copays, and your out-of-pocket maximum. Before December 7, read your own plan's 2027 premium alongside its out-of-pocket maximum, your copays, your drug coverage, and the extras you actually use. That comparison — not the headline average — tells you whether to stay or to shop.

This article was written with the help of generative AI.

For general information only, not medical advice.

Consult a qualified professional for your situation.

Medicare Advantage Premiums Fall to $12 on Average in 2027: What to Check Before December 7

Direct answer: The Centers for Medicare & Medicaid Services (CMS) projects the weighted average monthly Medicare Advantage premium will fall from $14.37 in 2026 to $12.00 in 2027, a decline of 16.5%. Medicare Open Enrollment for 2027 coverage runs October 15, 2026 through December 7, 2026. These are national averages and projections, not the price of any single plan, so check your own plan's 2027 costs before the deadline.

What did CMS project for 2027?

CMS announced the 2027 projections on September 28, 2026, ahead of open enrollment. The headline figures are averages across all Medicare Advantage plans, including plans with prescription drug coverage and Special Needs Plans.

Coverage	2026	2027 (projected)
Medicare Advantage, weighted average monthly premium	$14.37	$12.00 (down 16.5%)
Part D inside a Medicare Advantage drug plan, average monthly premium after rebates	$11.32	$7.00 (down 38%, a $4.32 drop)
Stand-alone Part D plan, average monthly premium	$35.09	$36.00 (up less than $1)

CMS also projects that supplemental benefits such as hearing, dental, and vision coverage will remain stable in 2027, and that about 8 in 10 Medicare Advantage beneficiaries will be able to stay in their current plan with the same or a lower premium.

Why does the average fall not mean every plan gets cheaper?

A weighted average blends many plans together, including plans with a $0 premium, and weights them by enrollment. Your own plan's premium, deductible, copayments, provider network, and drug list can still move in either direction. CMS itself urges beneficiaries to review their current coverage and compare 2027 options, because plan costs and benefits can change from year to year.

The total number of Medicare Advantage plans nationally is projected to stay nearly flat, from 5,553 in 2026 to about 5,532 in 2027. More than 99% of beneficiaries are projected to have access to at least one Medicare Advantage plan, and 97% to 10 or more choices. CMS estimates 2027 Medicare Advantage enrollment at 34 million, about 47.4% of all people enrolled in Medicare.

What should you check before December 7?

• Your plan's Annual Notice of Change. Compare the 2027 premium, deductible, copayments, and out-of-pocket maximum with your 2026 costs.
• Your doctors and pharmacies. Check whether they are still in network for 2027.
• Your medicines. Check the 2027 drug list and tier for each prescription, and the Part D premium that applies to your plan type.
• Extra benefits you actually use. Dental, vision, and hearing benefits are projected to stay stable nationally, but the details vary by plan.
• Help paying costs. Medicare Savings Programs may help pay premiums, deductibles, and copayments for people with limited income and resources, and Extra Help may help with Part D costs.

How can you compare 2027 plans?

Use the Medicare Plan Finder at Medicare.gov to compare premiums, costs, benefits, and drug coverage side by side. You can also call 1-800-MEDICARE, available 24 hours a day, 7 days a week, for help comparing plans and costs. People who want to keep their current Medicare coverage generally do not need to re-enroll, but CMS still recommends a yearly review during open enrollment.

Frequently asked questions

Is my Medicare Advantage premium $12 in 2027?
Not necessarily. $12.00 is the projected national weighted average. Your premium depends on your plan, your location, and your enrollment choices.

When does 2027 coverage start?
Medicare Open Enrollment runs October 15 through December 7, 2026, for coverage starting January 1, 2027.

Did stand-alone drug plan premiums fall too?
No. CMS projects the average stand-alone Part D premium will rise by less than $1, from $35.09 to $36.00. The larger drug-premium drop applies to drug coverage inside Medicare Advantage plans, from $11.32 to $7.00.

Where can I get help with my own plan?
Medicare.gov, the Medicare Plan Finder, and 1-800-MEDICARE publish plan-by-plan 2027 information. A local State Health Insurance Assistance Program counselor can also help with an individual comparison.

Key takeaway

CMS projects lower average Medicare Advantage premiums for 2027, led by a 16.5% drop in the weighted average monthly premium to $12.00 and a 38% drop in the average Part D premium inside Medicare Advantage drug plans to $7.00, while stand-alone Part D averages rise by less than $1 to $36.00. The averages are good news in general, but they do not describe any one plan, so use the open enrollment window ending December 7, 2026 to check your premium, network, drug list, and extra benefits before 2027 coverage begins.

Sources

• CMS press release: Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027, published September 28, 2026 — https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2027

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This post was created with the help of AI and is for general information only. It is not medical, legal, or financial advice, and it does not replace guidance from a licensed professional, a Medicare counselor, or an official source such as Medicare.gov or CMS. If a detail affects your coverage or your premium, please confirm it with Medicare or a qualified professional before acting.

 

Medicare Open Enrollment: 3 Numbers to Check Before December 7

Medicare Open Enrollment has been open since October 15, and the December 7 deadline is now closer than it feels. Between news stories, plan mailings, and advice from well-meaning friends, the numbers can start to blur together. So let us slow down and focus on just three of them.

In late September, the Centers for Medicare & Medicaid Services (CMS) published its projections for 2027. Three figures in that release are worth writing on an index card and holding up against your own plan: the average Medicare Advantage premium, the average stand-alone Part D premium, and the Part D out-of-pocket cap. Here is what each number means, and how to check it against your own coverage before the window closes.

1. Number One: $12 — The Average Medicare Advantage Premium for 2027

CMS projects that the average monthly premium across Medicare Advantage plans will be about $12 in 2027, down from $14.37 in 2026. That is the national average, weighted by enrollment, and it includes the many plans that charge no additional premium at all beyond Part B.

Your check is simple: find the 2027 premium for your plan in the Annual Notice of Change it mailed you this fall. If your premium is far above the $12 average, that is not automatically a problem — your plan may offer richer benefits or the network you rely on. But it is a reason to ask what the extra amount is buying you. And remember, this figure never replaces your Part B premium, which you keep paying either way.

2. Number Two: $36 — The Average Stand-Alone Part D Premium for 2027

If you have Original Medicare with a separate prescription drug plan, your benchmark is different. CMS projects the average premium for stand-alone Part D plans at about $36 a month in 2027, up slightly from $35.09 in 2026.

The small rise hides a bigger story. A temporary federal program that held Part D premiums down in 2025 and 2026 has ended, so individual plans are moving in different directions: some barely change, others rise much more than a dollar. That is why the average matters less than your own plan's 2027 premium, printed in your Annual Notice of Change. If your plan's increase is steep, the average tells you that calmer options may exist — if you compare before December 7.

3. Number Three: $2,400 — The Part D Out-of-Pocket Cap for 2027

The third number protects people who take expensive medications. In 2027, once your out-of-pocket spending on covered Part D drugs reaches $2,400 for the year, you pay $0 for covered drugs for the rest of the year. The cap rises from $2,100 in 2026, and it applies inside Medicare Advantage plans with drug coverage as well as in stand-alone Part D plans.

To use this number, add up roughly what you spent on prescriptions this year. If your total came anywhere near the cap, drug coverage is probably the most important part of your plan choice — more important than a small difference in premiums. A plan that covers your medications well can be worth far more than a cheaper plan that covers them poorly.

4. The Checklist: Put Your Plan Next to the Three Numbers

• Your 2027 premium: Find it in your Annual Notice of Change and compare it with the $12 Medicare Advantage average or the $36 stand-alone Part D average, whichever fits your coverage.
• Your medications: List each prescription with its dosage, and confirm every one is still on your plan's 2027 drug list, at a tier you can afford.
• Your drug spending: Estimate your yearly total at the pharmacy. If it approaches $2,400, weigh drug coverage heavily in your decision.
• Your doctors: If you are in a Medicare Advantage plan, confirm your doctors and hospital are still in the network for 2027.
• Your total yearly cost: Compare plans on premium plus deductible plus expected drug and care costs — not on premium alone.

5. If Your Numbers Look Worse Than the Averages

Do not panic, and do not ignore it either. Averages describe the whole country; your plan, your county, and your prescriptions describe you. A plan that costs more than average may still be the right plan. The averages simply tell you when it is worth a second look.

That second look is free. The Plan Compare tool at Medicare.gov lets you enter your medications and pharmacy and see estimated total yearly costs side by side. Your local State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling in person or by phone. Whatever you decide — switching or staying — decide it on your own numbers before December 7, while the choice is still yours to make.

Key Takeaway

Three 2027 numbers frame this enrollment season: an average Medicare Advantage premium of about $12 a month, an average stand-alone Part D premium of about $36 a month, and a $2,400 yearly cap on Part D drug spending. None of them is your number. Use them as a measuring stick: pull out your Annual Notice of Change, check your premium, your drugs, and your yearly drug spending against them, and compare total costs on Medicare.gov. A half hour with the checklist now beats a year of paying for a plan that no longer fits.

This article was written with the help of generative AI.

For general information only, not medical advice.

Consult a qualified professional for your situation.

Medicare Advantage vs. Original Medicare: Which Is Better for You?

Two neighbors can carry the same red-white-and-blue Medicare card and have completely different experiences at the hospital. One pays almost nothing for a week-long stay. The other, who sees doctors just as often, ends the year with thousands in bills. What made the difference? Usually, it is the path they chose: Original Medicare, or a Medicare Advantage plan. Neither is "better" for everyone — they are built on different trade-offs. This guide compares them side by side so you can see which trade-offs fit your life.

1. The Two Paths at a Glance

Original Medicare is the federal program itself: Part A for hospital care and Part B for doctors and outpatient care. You can add a standalone Part D plan for prescriptions, and many people also add a Medigap (supplement) policy to help with the deductibles and the 20% coinsurance. Premiums stack up — Part B, plus Part D, plus Medigap — but the combination can make your medical costs very predictable.

Medicare Advantage (Part C) is an all-in-one alternative sold by private insurance companies approved by Medicare. The plan replaces Original Medicare as your coverage (you still pay your Part B premium), usually bundles prescription drug coverage, and often adds extras like dental or vision allowances. In exchange, you agree to the plan's rules — its network, its approvals, and its cost-sharing structure.

2. Seeing the Doctors You Want: Networks

With Original Medicare, you can see any doctor or hospital in the country that accepts Medicare — and most do. There are no networks to check and, for most services, no referrals needed to see a specialist.

Medicare Advantage plans work through networks. HMO plans generally require you to use in-network providers (except emergencies) and may require a referral to see a specialist. PPO plans give more flexibility, including some out-of-network coverage at a higher cost. Networks change, and a plan that includes your doctors this year may not next year — so if you lean toward Medicare Advantage, checking your specific doctors and prescriptions in the plan's lists is an essential yearly habit.

3. Approvals Before Care: Prior Authorization

Original Medicare rarely requires approval before treatment. If Medicare covers the service and your provider orders it, it is generally covered.

Medicare Advantage plans frequently require prior authorization for things like imaging, surgeries, hospital stays, and some medications. That can mean waiting for the plan to agree the care is necessary, and occasionally a denial you or your doctor must appeal. Many people never run into a problem; others find the paperwork frustrating at exactly the wrong moment. If you expect significant treatment in the coming year, this difference deserves real weight.

4. Your Worst-Case Year: Is There a Cap on What You Can Owe?

This is the difference that surprises people most. Original Medicare has no out-of-pocket maximum. The 20% coinsurance for Part B services can grow without limit in a bad year — which is why many people pair Original Medicare with Medigap, where the supplement absorbs most of that risk in exchange for a monthly premium.

Every Medicare Advantage plan, by law, must have an annual out-of-pocket maximum for in-network Part A and Part B services. For 2026, federal rules allow that cap to be as high as $9,250, though many plans set theirs considerably lower — and once you reach your plan's cap, you pay $0 for covered in-network services for the rest of the year. Two cautions: your premiums do not count toward the cap, and the cap does not make a plan "cheap" — it only limits the worst case.

5. The Extras: Dental, Vision, Hearing, and More

Original Medicare does not cover routine dental care, eye exams for glasses, or hearing aids. Medicare Advantage plans commonly include some of these as extra benefits — a dental allowance, a vision benefit toward glasses, hearing aid coverage, fitness memberships, or a card for over-the-counter items.

These extras are genuinely useful, but read them carefully. A "dental benefit" might mean cleanings and X-rays only, or a yearly allowance of a set dollar amount that covers a fraction of major work. Benefits also change every year, and a plan can reduce or drop them at renewal. Treat extras as a welcome bonus, not the main reason to choose a plan.

6. Prescriptions and Travel

Most Medicare Advantage plans include Part D drug coverage in the same plan, with their own formulary (drug list) and pharmacy network. With Original Medicare, you choose a separate Part D plan — more pieces to manage, but you can pick the drug plan that fits your medications independently of your medical coverage.

For travel, Original Medicare works anywhere in the United States with any Medicare-accepting provider, which suits snowbirds and frequent travelers. Medicare Advantage coverage outside your plan's service area is generally limited to emergency and urgently needed care (PPOs offer more flexibility). Neither path covers most care outside the U.S., though some Medigap plans include a limited foreign travel emergency benefit.

7. What Each Path Really Costs

Medicare Advantage often wins on monthly price: many plans charge $0 in additional premium beyond Part B, and the average plan premium is under $20 a month. You then pay copays and coinsurance as you use care — small in a healthy year, larger in a sick one, up to the cap.

Original Medicare with Medigap usually costs more each month in premiums, but far less when you actually get care. Over a healthy decade the Advantage route may cost less in total; one serious illness can flip the math. The honest way to compare is to estimate your likely year: your regular doctors, your prescriptions, and the procedures you already know are coming.

8. A Simple Way to Decide — and When You Can Change

1. List your non-negotiables. Specific doctors? Freedom to travel? A hard limit on worst-case spending? Your answers point to a path quickly.
2. Price your real medications. Use the plan comparison tools at medicare.gov with your actual prescriptions and pharmacy.
3. Stress-test the bad year. Compare "healthy year" and "hospital year" costs for each option, not just the premium.
4. Know your switching windows. You can change coverage during Open Enrollment (October 15 to December 7) each year, and Medicare Advantage members have an additional window from January 1 to March 31. One warning: moving back to Original Medicare is easy, but buying a Medigap policy afterward may involve health questions unless you qualify for a trial right or guaranteed issue situation — so think carefully before giving up a Medigap policy you bought when you were first eligible.

Key Takeaway

Original Medicare offers freedom — any Medicare provider nationwide, few approvals — but no built-in spending cap, so most people add Medigap and Part D and pay higher monthly premiums for predictability. Medicare Advantage offers convenience and extras at a low premium, with a guaranteed out-of-pocket cap (up to $9,250 in-network in 2026), in exchange for networks and prior approvals. The right choice is the one that fits your doctors, your medications, your travel, and your tolerance for a bad year's bills — and it is worth re-checking every fall.

This article was written with the help of generative AI.

For general information only, not medical advice.

Consult a qualified professional for your situation.