Medicare Part B vs. Medicare Advantage: Differences, Pros & Cons

Updated: April 22, 2026

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Key Takeaways
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Medicare Part B vs. Medicare Advantage comes down to network freedom versus bundled extra benefits at lower premiums.

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Most Medicare Advantage plans charge $0/month beyond the Part B premium in 2026, per MoneyGeek's analysis of CMS data.

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Medicare Advantage plans must cover everything Part B covers, plus dental, vision and hearing in most plans.

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You can switch between Part B and Medicare Advantage each year during the Annual Enrollment Period in October.

What Is Medicare Part B?

Medicare Part B is the outpatient coverage component of Original Medicare. Part B pays 80% of approved costs for doctor visits, preventive care, outpatient surgery, lab tests and durable medical equipment after the $283 annual deductible, per CMS.gov. The 2026 standard premium is $202.90/month. Unlike Medicare Advantage, Part B lets you see any Medicare-accepting provider in the country with no referrals, no network restrictions and no prior authorization.

Part B is available to anyone enrolled in Medicare Part A who is 65 or older, or who qualifies through disability or end-stage renal disease per CMS.gov. Higher-income enrollees pay more via the Income-Related Monthly Adjustment Amount (IRMAA), reaching $628.90/month at the highest income tier in 2026 per CMS.gov. The full range of health insurance options available under Medicare depends on enrollment timing, income and whether you want original coverage or a bundled private plan.

What Is Medicare Advantage?

Medicare Advantage, also called Part C, is a private insurance alternative to Original Medicare that bundles Part A, Part B and usually Part D into one plan. In 2026, 60% of Medicare Advantage plans charge $0 beyond the required Part B premium, per MoneyGeek's analysis of CMS data. Plans are offered by private insurers approved by CMS, and they vary by county, network type and benefit structure.

CMS assigns annual star ratings of 1 to 5 to each Medicare Advantage plan. Plans rated 4.0 or higher indicate strong care coordination and lower denial rates.

How Do Medicare Part B and Medicare Advantage Compare?

The most important difference between Medicare Part B and Medicare Advantage is not the monthly premium. It's what you give up in exchange for a lower monthly bill. Medicare Advantage plans lock you into a contracted provider network and may require prior authorization for services that Original Medicare approves without any insurer review. For enrollees with straightforward, in-network care needs, that trade-off is manageable. For enrollees with out-of-network specialists or care needs that cross state lines, it's a real constraint.

2026 monthly premium
$202.90/month per CMS.gov
$0 median (60% of plans). Plans charging a premium average $53/month (HMO) and $63/month (PPO) per MoneyGeek's CMS data analysis.
Annual deductible
$283 per CMS.gov
Varies by plan. Many plans at $0. Drug deductible up to $615.
Maximum out-of-pocket (2026)
No cap without Medigap
$9,250 average in-network per MoneyGeek's CMS data analysis
Provider network
Any Medicare-accepting provider, nationwide
In-network only (HMO). Partial out-of-network (PPO).
Referrals required
No
Yes for HMO. No for PPO.
Prior authorization
Not required
Required for many services and procedures
Dental, vision, hearing
Not covered
Included in most plans
Prescription drug coverage
Separate Part D plan required
Built into most plans. Annual drug spending capped at $2,100.
Out-of-area routine care
Covered at any Medicare provider
Not covered in most HMO plans
Out-of-area emergency care
Covered nationwide
Covered nationwide per CMS.gov federal rules
Plan stability
Benefits and cost-sharing set by CMS annually
Network, benefits and premiums can change each January

Confirm premiums, network rules and out-of-pocket caps in each plan's Evidence of Coverage before enrolling. Plan details vary by insurer and county. Data sourced from CMS.gov 2026 Medicare plan data and MoneyGeek's analysis of 64,249 Medicare Advantage plans.

What Does Medicare Part B Cost in 2026?

The standard Part B premium catches many enrollees off guard because it's not the full cost of Original Medicare. The $202.90/month premium applies to most enrollees in 2026 per CMS.gov, but 20% coinsurance on covered services has no annual ceiling without a Medigap supplement. An enrollee with a major surgery or extended outpatient treatment can owe tens of thousands of dollars in coinsurance before a Medigap plan is added to the picture.

Standard monthly premium
$202.90
Annual deductible
$283
Coinsurance after deductible
20% of Medicare-approved amount
Maximum out-of-pocket cap
None without Medigap
IRMAA surcharge (starts at)
+$74.90/month (individual income above $109,000)
Medigap Plan G avg. monthly premium (age 65)
$100 to $200 (varies by state and insurer)

*IRMAA thresholds are based on 2024 reported income applied to 2026 premiums per CMS.gov. Medigap premium ranges are market estimates. Confirm with individual insurers.

What Does Medicare Advantage Cost in 2026?

Most Medicare Advantage plans charge $0 beyond the required Part B premium in 2026. Among plans that do charge a premium, HMOs average $53/month and PPOs average $63/month, per MoneyGeek's analysis. The cost picture extends beyond the monthly premium. Enrollees pay a copay at every covered visit, and those copays accumulate. The 2026 average in-network maximum out-of-pocket of $9,250 per MoneyGeek's CMS analysis sets the ceiling on annual out-of-pocket spending, though most enrollees with routine care needs won't approach that limit. The average cost of health insurance under Medicare Advantage is lower for healthy enrollees who stay in network.

Monthly premium (median)
$0 (60% of all plans)
Beyond required $202.90 Part B premium. 
Monthly premium (average, excl. $0 plans)
$53/month (HMO) / $63/month (PPO)
Annual medical deductible
$0 on many plans
Varies by plan and county.
Annual drug deductible
Up to $615
For plans with prescription drug coverage.
Primary care visit copay
$0 to $20 (typical HMO range)
Varies by plan and county.
Specialist visit copay
$20 to $50 (typical HMO range)
Referral required in most HMO plans.
Average in-network MOOP (2026)
$9,250 (all plan types)
Combined in- and out-of-network MOOP (2026)
Up to $14,000
Per CMS.gov federal cap for PPO plans.
Annual drug spending cap
$2,100
Once reached, covered medications cost $0 through Dec. 31.
Part D drug coverage
Included in most plans
Confirm formulary before enrolling.

*Costs vary by plan, county and insurer. Confirm 2026 figures in each plan's Evidence of Coverage. Data sourced from MoneyGeek's analysis of CMS 2026 Medicare Advantage plan data (64,249 plans).

Which Plan Covers More: Part B or Medicare Advantage?

Medicare Advantage plans cover everything Part B covers. That's a federal requirement per CMS.gov. Every Medicare Advantage plan must provide the full scope of Original Medicare benefits as a baseline. Where the two diverge is what they add above that floor. Most Medicare Advantage plans include dental, vision and hearing coverage that Part B excludes. Whether those benefits translate into real value depends on whether your preferred dentist, optometrist and audiologist are inside the plan's contracted network.

Doctor visits
Covered (80% after deductible)
Covered (copay applies)
Outpatient surgery
Covered
Covered
Preventive care
Covered ($0 for listed preventive services)
Covered
Lab tests and imaging
Covered
Covered
Durable medical equipment
Covered (80% after deductible)
Covered (plan cost-sharing applies)
Emergency care (out-of-area)
Covered nationwide
Covered nationwide per CMS.gov
Mental health (outpatient)
Covered
Covered
Prescription drugs (Part D)
Not included. Separate plan required.
Included in most plans
Routine dental
Not covered
Covered in most plans
Routine vision
Not covered
Covered in most plans
Routine hearing
Not covered
Covered in most plans
Fitness benefits
Not covered
Offered by many plans
Transportation to appointments
Not covered
Offered by some plans
Over-the-counter allowance
Not covered
Offered by some plans

*Medicare Advantage extra benefits vary by plan and county. Confirm inclusions in each plan's Evidence of Coverage. Per CMS.gov, all Medicare Advantage plans must cover the full scope of Original Medicare benefits.

Extra Benefits Medicare Advantage Offers That Part B Doesn't

Most Medicare Advantage plans include dental, vision and hearing as standard, with no additional premium required. CMS.gov data shows these benefits are available in the majority of plans nationally in 2026, though scope varies widely. 

  • Dental: Most plans cover preventive dental (cleanings, x-rays). Some include restorative coverage (fillings, crowns). Annual benefit maximums range from $1,000 to $3,000 on most plans.
  • Vision: Routine eye exams plus a glasses or contact lens allowance of $100 to $200/year are included in most plans.
  • Hearing: Routine exams and a hearing aid allowance are included in many plans. Covered amounts vary by plan.
  • Part D drug coverage: Most Medicare Advantage plans include built-in prescription drug coverage with a $2,100 annual drug spending cap, eliminating the need for a separate Part D plan.
  • Supplemental benefits: Some plans include fitness memberships, transportation to medical appointments, over-the-counter allowances and meal delivery after a hospital stay.

Where Part B Has an Edge Over Medicare Advantage

Part B's advantage is access, not cost. Any Medicare-accepting provider nationwide is covered with no prior authorization and no referral required. For enrollees managing a complex condition, seeing specialists in multiple locations or spending part of the year in a second state, that access is the deciding factor.   

  • No prior authorization delays: Part B pays its 80% share for any covered service once a claim is submitted. Medicare Advantage plans may require pre-approval for specialist visits, imaging, surgeries and certain therapies.
  • No annual plan changes: Part B benefits and cost-sharing are set by CMS.gov each year and are consistent nationwide. Medicare Advantage plans can change their networks, copays and included benefits each January.
  • Nationwide routine care coverage: Original Medicare covers routine outpatient care at any Medicare provider in any state. Most Medicare Advantage HMO plans cover routine care only inside the plan's service area.
  • Simpler care coordination for complex cases: Patients managing cancer, advanced cardiac conditions or rare diseases often prefer Original Medicare because multi-provider care doesn't require referral chains or in-network confirmations at every step.

What Are the Pros and Cons of Medicare Part B vs. Medicare Advantage?

Medicare Part B offers nationwide access and coverage stability at a higher base cost. Medicare Advantage delivers extra benefits and lower monthly premiums within a defined network. The right choice depends on your health care usage, where you live and whether your preferred providers are in a plan's contracted network.

Medicare Part B (Original Medicare)
Medicare Advantage

Pros

  • Any Medicare-accepting provider nationwide, no referrals required
  • Pairing with Medigap Plan G eliminates uncapped 20% coinsurance exposure
  • Covered services paid without insurer pre-approval
  • Benefits and cost-sharing rules are consistent year to year
  • $0 median monthly premium in 2026 (60% of plans), per MoneyGeek's CMS analysis. Plans with premiums average $53/month (HMO)
  • Dental, vision and hearing included in most plans at no extra premium
  • Out-of-pocket spending capped at $9,250 average in-network per MoneyGeek's CMS data analysis
  • Part D drug coverage built into most plans, with a $2,100 annual drug spending cap

Cons

  • $202.90/month Part B premium plus $100 to $200/month for Medigap Plan G to close coverage gaps
  • Dental, vision and hearing not covered under Original Medicare
  • Separate standalone Part D plan required for drug coverage -
  • 20% coinsurance has no annual ceiling under Original Medicare alone
  • Care restricted to contracted providers. Out-of-network routine care not covered on HMO plans
  • Prior authorization required for many services, which can delay specialist visits
  • Plan networks, copays and benefits can change each January
  • Out-of-area routine care not covered in most HMO plans

When Does Medicare Part B Work Better Than Medicare Advantage?

Original Medicare with Medigap Plan G costs roughly $302.90 to $402.90/month total in 2026 ($202.90 Part B premium plus $100 to $200 for Plan G depending on age and state), but it covers all Medicare-approved services nationwide with no network limits after the $283 deductible.   

  • A retiree who sees a specialist not contracted with any local Medicare Advantage plan, splits time between two states or manages a chronic condition requiring care from multiple providers often pays less in total annual costs under this structure despite the higher monthly outlay.
  • Consider an enrollee with a cardiologist in Boston and a primary care doctor in Florida. Both accept Medicare.

Under Original Medicare, both visits are covered at the standard rate with no referral and no pre-approval required. Under a Medicare Advantage HMO, one provider is likely out of network and either uncovered or subject to a separate, higher cost-sharing tier entirely.

When Does Medicare Advantage Make More Financial Sense?

An enrollee in a large metro area with a $0-premium Medicare Advantage HMO avoids $2,434.80/year in additional plan premiums beyond the required Part B premium ($202.90 × 12 = $2,434.80). This figure represents the additional Medicare Advantage premium avoided, not a waiver of the Part B premium itself, which all Medicare enrollees continue to pay regardless of plan type. The meaningful financial comparison is against Original Medicare plus Medigap Plan G, which costs $302.90 to $402.90/month total in 2026. Compared to that baseline, a $0-premium Medicare Advantage plan saves $1,200 to $2,400/year in Medigap Plan G premiums.

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    For an enrollee who stays in network and uses care predictably, the total annual saving compared to Original Medicare plus Medigap Plan G reaches $1,200 to $2,400. Among the best-rated Medicare Advantage plans, CMS star ratings of 4.0 or higher correlate with lower denial rates and stronger care coordination.

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    A healthy 67-year-old in Phoenix with one primary care doctor, annual dental cleanings and a need for prescription eyeglasses pays less under Medicare Advantage across every cost dimension: $0 premium beyond Part B, $20 copays per visit, dental and vision included, and a $9,250 average MOOP cap that won't be reached in a routine year. For this profile, Original Medicare plus Medigap is a more expensive structure with benefits this enrollee's usage pattern won't recover.

When Can You Switch Between Medicare Part B and Medicare Advantage?

You can switch between Original Medicare and Medicare Advantage during three windows: the Initial Enrollment Period when you first become eligible, the Annual Enrollment Period (AEP) from Oct. 15 to Dec. 7 each year, and the Medicare Advantage Open Enrollment Period (OEP) from Jan. 1 to March 31. AEP changes take effect Jan. 1. OEP changes take effect the first day of the following month. CMS.gov publishes exact deadline dates each year at medicare.gov.

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    Annual Enrollment Period (Oct. 15 to Dec. 7)

    The Annual Enrollment Period is the primary switching window for all Medicare beneficiaries. 

    1. During AEP, any enrollee can move from Original Medicare to Medicare Advantage, switch from one Medicare Advantage plan to another or return from Medicare Advantage to Original Medicare. All changes take effect Jan. 1 of the following year.
    2. One important caveat applies when returning to Original Medicare from Medicare Advantage: in most states you may lose your guaranteed-issue right to purchase Medigap. Insurers can use medical underwriting and deny coverage or charge higher premiums based on your health history if you missed your initial Medigap open enrollment window. 
      Confirm your state's rules at medicare.gov before switching.
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    Medicare Advantage Open Enrollment Period (Jan. 1 to March 31)

    The Medicare Advantage Open Enrollment Period gives current Medicare Advantage enrollees a second opportunity each year to switch plans or return to Original Medicare. This window is available only to enrollees already in a Medicare Advantage plan on Jan. 1. New Medicare beneficiaries cannot use OEP to make their initial election.   

    Changes made during OEP take effect the first day of the month following the request. You can switch to a different Medicare Advantage plan or drop Medicare Advantage and return to Original Medicare during OEP, but you cannot use it to move from Original Medicare into Medicare Advantage for the first time.

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    Special Enrollment Periods

    Special Enrollment Periods (SEPs) allow enrollees to switch plans outside the standard windows when a qualifying life event occurs. Per CMS.gov, qualifying events include moving outside your current plan's service area, losing your current plan because it's leaving Medicare, qualifying for Extra Help (Low Income Subsidy) and gaining or losing Medicaid eligibility.   

    Most SEPs provide a two-month window from the date of the qualifying event. The Medicare enrollment process explains how to act on an SEP before the window closes. Missing the SEP window means waiting until the next Annual Enrollment Period in most cases.

Medicare Part B or Medicare Advantage: Which Option Fits Your Situation?

Medicare Advantage costs less monthly and bundles dental, vision and hearing, but it ties you to a network. Original Medicare lets you see any Medicare provider, nationwide, with no approvals required. If you travel, use out-of-network specialists, or want coverage stability year to year, pair Part B with Medigap. If you stay local and want lower premiums with extra benefits, Medicare Advantage wins.

Medicare Advantage vs. Medicare Part B: FAQ

The most frequently asked questions about Medicare Part B vs. Medicare Advantage are answered below, covering 2026 costs, coverage differences, switching windows and emergency care rules:

Did Medicare Advantage premiums or out-of-pocket limits change for 2026?

Which plan is better if you have a chronic condition requiring multiple specialists?

Can you switch from Medicare Advantage back to Original Medicare?

Does Medicare Part B or Medicare Advantage cover spouses differently?

Do Medicare Advantage plan options differ depending on where you live?

Does Medicare Advantage cover emergency care outside your plan's service area?

About Mark Fitzpatrick

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Mark Fitzpatrick, a Licensed Property and Casualty (P&C) Insurance Producer in Connecticut, is MoneyGeek's resident insurance expert. He has analyzed the insurance market for almost a decade, first with LendingTree and now with MoneyGeek, conducting original research on hundreds of insurance companies and millions of insurance rates for insurance shoppers. 

He writes about economics and insurance on MoneyGeek, breaking down complex topics so people can have confidence in their purchase. Like all MoneyGeek analysts, Mark collects and analyzes independent cost and consumer experience data on insurance companies to provide objective recommendations in our content that are independent of any of MoneyGeek's insurance company partnerships. 

His insights — on products ranging from car, home and renters insurance to health and life insurance — have been featured in The Washington Post, The New York Times and NPR among others. 

Mark holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He started his career working in financial risk management at State Street before transitioning to analysis of the personal insurance market. He's also a five-time Jeopardy champion!

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