Medicare questions, answered
Should I stay on Original Medicare or switch to Medicare Advantage?
What each path covers, what it leaves to you, and the three things to check before you change anything.
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By Christian Brinkley, Licensed Insurance Agent, Greensboro, NC. Updated October 1, 2026.
Neighbors ask me some version of this every fall: is there any reason not to switch to basic Medicare, or to Medicare Advantage? Both are real choices, and neither one is right for everybody. Here is how they work, so you can check them against your own life.
What Original Medicare covers, and what it leaves to you
People call Original Medicare “basic Medicare.” It has two parts. Part A covers hospital stays. Part B covers doctor visits, outpatient care, and preventive care.
It also leaves some costs with you:
- Part A has a deductible of $1,736 for each benefit period in 2026.
- Part B has a $283 deductible in 2026. After that, you usually pay 20% of the Medicare-approved amount for most services.
- There is no yearly cap on what you can pay for Part A and Part B services.
- It does not include prescription drug coverage. That comes from a separate Part D plan.
On top of those costs, you pay the Part B premium, which is $202.90 a month for most people in 2026.
Why some people stay on Original Medicare
With Original Medicare, you can see any doctor or hospital in the country that accepts Medicare. There is no network to stay inside, and you generally do not need a referral to see a specialist.
Many people who stay add two things: a Medicare Supplement (Medigap) policy, which helps pay deductibles and coinsurance, and a Part D drug plan. Those come with their own monthly premiums. The tradeoff is a more predictable bill when you get care, in exchange for paying for three separate pieces.
Why some people switch to Medicare Advantage
A Medicare Advantage plan is sold by a private insurance company. It replaces Original Medicare for your Part A and Part B benefits, and most plans include drug coverage in the same package.
Many plans have a low or even $0 plan premium, though you still pay your Part B premium. Plans must have a yearly limit on what you pay for covered services. Some add extras like dental, vision, or hearing, and those vary a lot from plan to plan.
The tradeoffs are networks and approvals. Most plans work with a set list of doctors and hospitals. Some services need the plan’s approval before you get them, which is called prior authorization. Copays differ by service and by plan.
Three things to check before you change anything
- Your doctors. Look up each doctor, specialist, and hospital you use. Check them plan by plan, not just the insurance company’s name.
- Your prescriptions. Check that each medicine is covered, what tier it is on, and what it costs at your pharmacy.
- What you pay now versus next year. Add up premiums and likely copays for a normal year, then picture a year with a hospital stay.
One more thing to know. If you leave a Medicare Advantage plan later and want a Medigap policy, the company may ask health questions and can say no in most situations. Read Medicare.gov’s guidance on when you can buy Medigap before you drop anything.
When you can change
The Annual Enrollment Period runs October 15 to December 7 every year. Changes you make then start January 1. You can switch between Original Medicare and Medicare Advantage, or from one Advantage plan to another.
If you are already in a Medicare Advantage plan, there is a second window from January 1 to March 31. You can switch to a different Advantage plan or go back to Original Medicare. Moves, loss of other coverage, and a few other life changes can open a special window too.
Questions people ask me about this
- Any reason not to switch to basic Medicare?
- Yes, a few. Original Medicare has no yearly cap on what you pay and no drug coverage, so most people add a Medigap policy and a Part D plan. Those cost extra each month. Whether that fits depends on your doctors, your medicines, and your budget.
- Does Original Medicare cover prescriptions?
- No. Prescription coverage comes from a separate Part D plan, or from a Medicare Advantage plan that includes drug coverage.
- Is there an out-of-pocket maximum with Original Medicare?
- No. After the deductibles, you usually pay 20% of the approved amount for most Part B services, with no yearly limit. A Medigap policy can help cover that. Medicare Advantage plans do have a yearly limit.
Talk it through with a local agent, free: request a time at christianbrinkleync.com/start or call/text (919) 408-6671.
Sources
- CMS: 2026 Medicare Parts A and B premiums and deductibles
- Medicare.gov: When you can join, switch, or drop a Medicare Advantage plan
- Medicare.gov: What does Medicare cost?