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I recommend driving both and then coming to a decision. Personally I feel the Pilot is a much better value not just based on price, but also feature content and interior space. MDX has a relatively tighter space as it is more form over function while the Pilot is function over form. The Pilot also has classic SUV looks that I like.
However, if you were to compare the MDX Type S vs. the Pilot, then I would pick the Type S as it has a more powerful engine, air suspension, and more performance oriented. It all comes down to what you need and what your prioritize. Both are great SUVs and you will not go wrong with either one of them.
 

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My wife and I are currently shopping for our first SUV and have narrowed it down to either a 2023 Pilot Elite or a 2023 Acura MDX (most likely A-spec). We have also driven the Telluride, Palisade, VW Atlas, and Pathfinder. We have looked at the Grand Cherokee as well. For whatever reason haven’t considered the Highlander. We loved the telluride and Hyundai but just can’t buy them feeling confident about reliability. We could be totally wrong and in 10 years find the 2023 pilot was a complete hunk of junk vs those two. At this point we are most likely going to choose the Pilot over the MDX. This decision is being made with the following conditions in our market: Acuras are readily available for about 5% below MSRP (about 3K to 4K below MSRP depending on trim level) and 3.9% financing. 2023 Pilots are at MSRP, probably around 4.5-4.9% financing, but no one has an Elite in stock and we are being quoted March/April availability. The main reason we want an Elite over any MDX: the 360 camera is highly desired by my wife who has never driven an SUV. You can’t get a camera like that in an MDX unless you go to the Advance package which is out of our budget. She also likes the front ventilated seats in the Elite and the 3-prong plug (though hasn’t given me a clear answer about what she would use it for), as reason to pick it over the Touring. I love the 2023 Pilot with the only two hesitations: (1) the side cameras I n our two current Hondas are no longer available on any Honda (but both telluride and palisades have them). We got used to having a camera view on our right side instead of using the mirror and it will be missed. (2) I don’t love the idea of buying a car first year of redesign and being on the bleeding edge of any recalls. I have seen 3 different 2023 Pilots in person and none of them had a misaligned hood as has been posted on this forum. One salesmen opened and closed the hood without any force and it aligned and shut fine. The MDX is more luxurious than the Pilot and has a sexier exterior but the few reasons against it are: (1) 3rd row is much smaller. At 6ft2 I couldn’t put my head straight up without hitting the ceiling. The window felt smaller and my wife did she was nauseous sitting back there. Pilot was much better. (2) no 360 camera on Lower trim, (3) no remote start on lower trims (but they are doing 3-year free Acura link on all 2023s and after that remote start from an app will cost about $110 per year, (4) recommended premium gas where in my area is about $1 to $1.30 more than regular, (5) true touch in Acura took a while to get used to vs actual touch screen in the Pilot, (6) about 20% less cargo space than the Pilot. Overall, the MDX is a sexier car and If you care more about looking good, it’s not a bad choice. With my current market and interest rate incentives you can get a MDX Technology package cheaper than an Elite and the gas/maintenance may be a bit of a wash with theoretically higher resale value on the MDX in 5 years. But for us the pilot is an amazing car.
Both the Pilot and the MDX are excellent choices for a family SUV. Contrary to what you might hear on the MDX forum, the Pilot and MDX are built on the same platform and share a lot in common and there is not much of a difference other than creature comforts, looks, front suspension, and interior space. Objectively, the Pilot is a better buy than the NON Type S MDX.

Also, I do not believe you are REQUIRED to put premium in the MDX. It is only recommended and this topic has been beaten to death. For the MDX Type S, definitely premium.
 

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Question - IN THE PAST has there been more of a difference between Pilot and MDX? Meaning, yes they might have shared a chassis or something but they were more different than they are now? I am always just curious at some of the guffaws from MDXers but most all of the guffaws come from people who own prior generation MDXs. I know some people just overplay the Acura brand or the "sportiness" or whatever but I am wondering if they are just not up to speed on the similarities in the latest iterations of a common platform
In a way yes. The earlier generations had a double wishbone front suspension and a more powerful J series engine. For example, the MDX was about 50 HP more than the Pilot. So, you’re right in the assumption that people who owned these earlier generations felt a perceivable difference in power, ride, and handling.
However, with the 3rd gen, the MDX actually dropped in HP and used a cheaper front strut based suspension and the Pilot became more powerful and came equipped with better AWD system. Now the Pilot is closing the gap with the non type S MDX.
 
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