Your two main paths
Medicare has four parts. Part A covers hospital care. Part B covers doctors and outpatient care. Part C is Medicare Advantage, private plans that replace A and B. Part D covers prescription drugs. In practice, you pick one of two paths:
| Original Medicare + Medigap + Part D | Medicare Advantage (Part C) | |
|---|---|---|
| Doctors | Any provider that accepts Medicare, nationwide | Usually a network; out-of-network care may cost more or not be covered |
| Annual out-of-pocket cap | None on Original Medicare alone; Medigap fills most gaps | Required; up to $9,250 in network in 2026 (average $5,421) |
| Premiums | Part B + Medigap premium + Part D premium | Part B; 75% of individual MA-PD enrollees pay no extra plan premium |
| Extras | No routine dental care such as cleanings, fillings or dentures | 98% of individual-plan enrollees have dental, 95% hearing, over 99% vision benefits |
Source: KFF, "Medicare Advantage in 2026" (June 5, 2026); Medicare.gov. Checked October 2026.
KFF counts 35.2 million people, or 55% of eligible beneficiaries, in Medicare Advantage in 2026. Popularity does not make it right for everyone. The right path depends on your health, your doctors, where you live and travel, and how much cost uncertainty you can absorb.
What Original Medicare costs in 2026
| Item | 2026 amount |
|---|---|
| Part B standard premium | $202.90 a month (higher at higher incomes) |
| Part B deductible | $283 a year, then usually 20% coinsurance |
| Part A premium | $0 for most people; $311 a month with 30–39 quarters of covered work, $565 with fewer than 30 |
| Part A hospital deductible | $1,736 per benefit period |
| Hospital days 61–90 | $434 a day |
| Lifetime reserve days 91–150 | $868 a day |
Source: CMS, "2026 Medicare Parts A & B Premiums and Deductibles" (Nov. 14, 2025); Medicare.gov, "Medicare costs."
Medicare.gov is blunt about the biggest risk: "There's no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage." Here is what that means in numbers. If you need $30,000 of Part B care in a year, such as outpatient cancer treatment, you pay the $283 deductible plus 20% of the remaining $29,717, about $6,226. A second year of treatment costs about the same again. This is why most people on Original Medicare add Medigap or have retiree coverage.
For 2027, the Medicare trustees project a Part B premium of $209.50 and a deductible of $292. CMS had not announced the official 2027 amounts as of early October 2026.
Medigap: when you can buy it matters more than which plan
Medigap (Medicare Supplement Insurance) is sold by private insurers and pays some or all of what Original Medicare leaves behind. Plans are standardized by letter in most states, so a Plan G from one insurer has the same benefits as a Plan G from another. Only price and service differ. Massachusetts, Minnesota and Wisconsin use their own standards.
- Plan G is the most popular, covering about 39% of Medigap enrollees in 2023, according to AHIP data cited by NerdWallet. It covers everything except the Part B deductible.
- Plans C and F cannot be bought by anyone who first became eligible for Medicare on or after January 1, 2020.
- Prices vary widely. NerdWallet found a 65-year-old nonsmoking woman in Atlanta could pay as little as $129 a month for Plan G, $44 for high-deductible Plan G, or $66 for Plan K.
The six-month window
Your Medigap Open Enrollment Period lasts six months, starting the first month you have Part B and are 65 or older. It happens once. During it, an insurer must sell you any Medigap policy it offers and cannot use medical underwriting. After it ends, Medicare.gov warns, an insurer can deny you a policy if you don't meet its health requirements. Some situations give you a guaranteed issue right later, and some states add more protections. Check with your state insurance department.
The Medicare Advantage trial right
If you join a Medicare Advantage plan when you first become eligible at 65, or drop a Medigap policy to try Medicare Advantage for the first time, you have 12 months to change your mind. Return to Original Medicare within that year and you keep a guaranteed right to buy Medigap. Miss it and you may never qualify for Medigap again if your health changes.
Medigap policies sold after 2005 do not include drug coverage, so you also need a Part D plan. You cannot use Medigap to pay Medicare Advantage costs, and you cannot buy Medigap while in an Advantage plan unless you are switching back.
Part D drug coverage: the 2026 and 2027 caps
Since the Part D redesign, annual out-of-pocket drug costs are capped. The cap is $2,100 in 2026. CMS's final 2027 rate announcement (April 6, 2026) raises it to $2,400 for 2027 and raises the maximum Part D deductible from $615 to $700. In 2026 the maximum Part D deductible is $615, covered insulin costs no more than $35 a month, and the Medicare Prescription Payment Plan lets you spread your drug costs into monthly payments across the year instead of paying large amounts at the pharmacy in January.
Two plans with the same premium can cost you very different amounts. Enter your exact drugs and pharmacy in the Medicare Plan Finder to compare total yearly cost, not just the premium.
Medicare Advantage: what to check
- Network. Confirm your doctors, specialists and hospitals are in network for 2027, not just 2026. Networks change.
- Out-of-pocket maximum. CMS caps in-network costs at $9,250 for 2026, but the average plan's limit is $5,421. A lower limit is real protection in a bad year.
- Prior authorization. Nearly every enrollee is in a plan that requires approval for some services. Ask how the plan handles the care you use most.
- Extra benefits. Dental, vision and hearing benefits are common but usually capped. Compare limits against our dental insurance guide and vision insurance guide to see what stand-alone coverage would cost.
- Travel. If you split the year between states, a local network may not work for you.
For a closer look at individual Advantage carriers, see our Medicare Advantage plans guide.
How to use star ratings
CMS rates Medicare Advantage and Part D plans from one to five stars each fall, based on quality and member experience measures. The 2027 ratings, posted to the Medicare Plan Finder on October 8, 2026, apply to the plans you choose during this Open Enrollment. The enrollment-weighted average for Advantage plans with drug coverage is 3.99, down slightly from 4.01. About 71% of those enrollees are in plans rated four stars or higher, and 15 of 508 rated contracts earned five stars. Stand-alone drug plans averaged 3.22 on their Part D rating.
Use stars as a tiebreaker, not the main test. A five-star plan with your doctors out of network is a poor fit. There is one practical bonus: a special enrollment period lets you switch into a five-star plan once between December 8 and November 30.
Key enrollment periods
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months around your 65th birthday | Sign up for Parts A and B; join an Advantage or drug plan |
| Medigap Open Enrollment | 6 months from the first month you have Part B and are 65+ | Buy any Medigap policy without health questions |
| Open Enrollment | Oct. 15 – Dec. 7, 2026 | Switch, join or drop Advantage and drug plans for 2027; coverage starts Jan. 1 |
| Medicare Advantage Open Enrollment | Jan. 1 – Mar. 31 | If in an Advantage plan: switch plans once, or return to Original Medicare and add Part D |
| Special Enrollment Periods | Varies | Moving, losing coverage, getting Medicaid or Extra Help |
Source: Medicare.gov, "Joining a plan"; Medicare.gov, Medigap guaranteed issue rights.
Switching to Original Medicare during Open Enrollment does not by itself give you a right to buy Medigap. Outside your protected windows, apply for Medigap and get approved before you leave an Advantage plan.
Free help and how to avoid sales pressure
Every state has a State Health Insurance Assistance Program (SHIP) that offers free, unbiased, federally funded Medicare counseling. Find yours at shiphelp.org or call 1-877-839-2675. Because the counseling is unbiased, it is a good check on anything an agent tells you.
Under Medicare marketing rules, agents may not call you without your permission or visit your home uninvited. If someone pressures you, keep their business card or materials and report it to 1-800-MEDICARE (633-4227), the Senior Medicare Patrol at 877-808-2468, or 1-800-HHS-TIPS.
Budgeting for Medicare is part of retirement planning. Our 401(k) guide covers how to build the savings that will pay these premiums.
Frequently asked questions
What is the 2026 Medicare Part B premium?
The standard Part B premium is $202.90 a month in 2026, with a $283 annual deductible. People with higher incomes pay more. The 2027 amounts had not been announced as of early October 2026; the Medicare trustees project $209.50.
Is Medicare Advantage or Medigap better?
Neither is better for everyone. Medigap with Original Medicare lets you see any provider that takes Medicare and makes costs predictable, but you pay separate premiums. Medicare Advantage often has low or no added premium and extra benefits, but uses networks and prior authorization and can cost up to $9,250 in network in 2026.
Can I switch from Medicare Advantage to Medigap later?
You can return to Original Medicare during Open Enrollment or the Medicare Advantage Open Enrollment Period, but outside guaranteed issue situations a Medigap insurer can turn you down or charge more because of your health. The 12-month trial right protects first-time Advantage enrollees.
What is the Part D out-of-pocket cap?
Out-of-pocket spending on covered Part D drugs is capped at $2,100 in 2026. CMS has set the 2027 cap at $2,400, with a maximum deductible of $700.
When is Medicare Open Enrollment for 2027?
October 15 through December 7, 2026. Changes take effect January 1, 2027. If you are in a Medicare Advantage plan, you get another chance to switch from January 1 to March 31.
Where can I get free Medicare advice?
Your State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling. Find it at shiphelp.org or call 1-877-839-2675. You can also call 1-800-MEDICARE.
Does Original Medicare have an out-of-pocket maximum?
No. Medicare.gov states there is no yearly limit on what you pay out of pocket under Original Medicare unless you have supplemental coverage such as Medigap.
Sources
- Medicare.gov – Medicare costs
- Medicare.gov – Joining a health or drug plan
- Medicare.gov – Medigap guaranteed issue rights
- Medicare.gov – Medigap & Medicare Advantage Plans
- CMS – 2027 Medicare Advantage and Part D Star Ratings
- KFF – Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization
- KFF – Medicare Advantage in 2026: Enrollment Update and Key Trends
- AARP – Medicare Part B premium 2027 projections
- CMS – 2026 Medicare Parts A & B Premiums and Deductibles
- UnitedHealthcare – Part D changes
- NCOA – Updates to Medicare Part D 2026
- NCOA – State Health Insurance Assistance Program
- Becker's Hospital Review – CMS hikes Medicare Advantage rate 2.48% for 2027
- Medicare.gov – Dental services
- Medicare Rights Center – Marketing rules for Medicare plans
Rates, fees and terms change often. Figures were checked in October 2026; confirm current details with the provider before you apply.