Quick Read – Medicare Advantage’s $0 premium trades monthly savings for up to $9,250 worst-case annual out-of-pocket exposure, versus Medigap Plan G’s $283 deductible limit. – Switching from Medicare Advantage back to Original Medicare with Medigap typically requires medical…
derwriting, allowing insurers to deny coverage based on health history. – Nearly 3 million Advantage enrollees were forced to switch plans for 2026 as insurers exited markets, stripping preferred doctors and drug formularies without warning. – Medicare’s Initial Enrollment Period offers two options that look nothing alike on the enrollment screen. Plan A is a Medicare Advantage HMO with a $0 monthly premium
Plan B is Original Medicare plus a Medigap policy that runs $150 to $250 a month. The math looks settled before the reader scrolls. One figure complicates it, and it sits inside the Advantage plan’s Summary of Benefits: a maximum out-of-pocket limit of $9,250 in-network, with a combined in- and out-of-network cap of $13,900.
Those are the federal ceilings; the average enrollee actually faces a lower limit, around $5,421 for in-network care. But the average is not the point. The $9,250 marks the worst case a Medicare Advantage plan can hand you in 2026, the hard ceiling your costs reach before the plan starts covering 100 percent of allowed expenses.