What's the Difference Between Original Medicare and Medicare Advantage, and Which Is Better?
Direct answer
Original Medicare and Medicare Advantage are two different ways to get Medicare coverage.
Original Medicare generally gives you broader choice of doctors and hospitals that accept Medicare, but you usually add Part D for drugs and may want Medigap to help with costs Medicare leaves to you.
Medicare Advantage provides Part A and Part B through a private insurer, usually includes Part D, often includes extras such as dental or vision, and has a yearly out-of-pocket limit.
But it may use provider networks and require prior approval for some care.
Neither is automatically better.
Updated
What is Original Medicare?
Original Medicare means you get:
Part A
and
Part B
directly through Medicare.
You can add:
Part D for prescriptions
and
Medigap to help pay some of the costs Original Medicare leaves to you.
Why would someone choose Original Medicare?
The biggest reason is usually provider freedom.
You can generally see any doctor or hospital in the U.S. that accepts Medicare.
You usually do not need referrals to see specialists.
What is Medigap?
Medigap is optional private supplemental insurance that works with Original Medicare.
Depending on the Medigap plan, it can help pay things like:
- Part A hospital coinsurance and additional hospital costs
- the 20% share Original Medicare often leaves you for Part B services
- hospice coinsurance or copays
- skilled-nursing-facility coinsurance
- the Part A deductible
- in some plans, Part B excess charges
- in some plans, emergency medical care while traveling outside the U.S.
Not every Medigap plan covers every item.
Medigap generally does not cover:
- long-term nursing-home care
- routine dental
- routine vision
- hearing aids
- glasses
- private-duty nursing
- prescription drugs
What is Medicare Advantage?
Medicare Advantage is Part C.
You must have Part A and Part B.
Then a private Medicare-approved plan provides those benefits.
Most plans also include Part D.
Many include extra benefits such as dental, vision or hearing.
Why would someone choose Medicare Advantage?
It can feel simpler because more coverage is bundled into one plan.
Some plans have a $0 additional premium, although you still generally pay your Part B premium.
Medicare Advantage also has a yearly out-of-pocket maximum for covered Medicare services.
Original Medicare by itself does not.
What is the catch?
Networks and plan rules.
Depending on the plan:
- your doctor may need to be in network
- your preferred hospital may need to be in network
- you may need referrals
- you may need prior authorization
Can I buy Medigap with Medicare Advantage?
No.
Medigap works with Original Medicare.
Can I switch later?
You can change Medicare coverage during certain enrollment periods.
But there is a major caveat:
Switching from Medicare Advantage back to Original Medicare does not always mean you are guaranteed the Medigap policy you want.
Your federal Medigap Open Enrollment Period generally lasts six months beginning when you are 65 or older and enrolled in Part B.
Outside protected situations, federal law does not always force an insurer to sell you a Medigap policy.
State protections can be broader.
No one told me:
You can switch Medicare coverage later.
That does not always mean you can buy the Medigap policy you want later.
Original Medicare vs. Medicare Advantage worksheet
If this matters a lot to me:
| If this matters a lot to me... | Look more closely at Original Medicare | Look more closely at Medicare Advantage |
|---|---|---|
| I want broad access to doctors and hospitals that accept Medicare | Yes | No |
| I split time between states or travel frequently in the U.S. | Yes | No |
| I see several specialists in different health systems | Yes | No |
| I strongly dislike prior authorization | Yes | No |
| I am comfortable paying separate premiums for Part D and possibly Medigap | Yes | No |
| I want one private plan to bundle most of my coverage | No | Yes |
| Keeping monthly premiums low is especially important | No | Yes |
| Dental, vision or hearing extras matter a lot | No | Yes |
| My doctors and preferred hospital are in the plan network | No | Yes |
| I am comfortable checking networks and plan rules each year | No | Yes |
| A defined yearly out-of-pocket limit matters a lot | No | Yes |
This worksheet does not choose for you.
It tells you which side deserves a closer look.
The bottom line
Original Medicare generally gives you more provider freedom.
Medicare Advantage generally gives you a more bundled private plan with an annual out-of-pocket limit and often extra benefits.
Neither is automatically better.
The better question is:
Which tradeoffs matter more to me?