Medicare Advantage
How Medicare Advantage plans work, the 2026 out-of-pocket limits, when you can join or switch, and a calculator comparing costs with Original Medicare and Medigap.
Medicare Advantage vs Original Medicare cost calculator (2026)
What Medicare Advantage is
Medicare Advantage (Part C) plans are private plans approved by Medicare that replace Original Medicare's Parts A and B, and usually include drug coverage and extras such as dental, vision and hearing. You still pay the Part B premium ($202.90 a month standard in 2026). Plans typically use networks and prior authorization, and many have low or $0 premiums.
The out-of-pocket maximum
Unlike Original Medicare, every Advantage plan caps what you pay for covered care each year. For 2026 the federal limits are $9,250 for in-network services and $13,900 for in- and out-of-network services combined (KFF); many plans set lower caps. Original Medicare has no cap, which is why many people pair it with a Medigap plan like Plan G.
Choosing and switching
- Join or switch during open enrollment, October 15 to December 7, for coverage starting January 1.
- From January 1 to March 31, Advantage members can switch plans or go back to Original Medicare once.
- Going back later may make Medigap harder to buy in many states, since insurers can use medical underwriting after your first open enrollment period.
Common questions
What is the Medicare Advantage out-of-pocket maximum for 2026?
$9,250 for in-network services and $13,900 combined, though many plans set lower limits.
Do I still pay the Part B premium with Medicare Advantage?
Yes, $202.90 a month standard in 2026, plus any plan premium.
When can I switch Medicare Advantage plans?
October 15 to December 7, and once from January 1 to March 31.
Sources
- Medicare.gov: Medicare costs (2026)
- KFF: Medicare Advantage out-of-pocket limits
- Medicare.gov: Your coverage options
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General information, not financial, tax or legal advice. Check important numbers with the official source before acting on them.