When it’s time to choose a Medicare plan, you have two main options: Original Medicare (Parts A and B) or Medicare Advantage (Part C). Both provide health coverage but work in different ways.
If you want the freedom to see any doctor who accepts Medicare, Original Medicare might be the better fit. But if you prefer a plan that bundles hospital, medical, and often prescription drug coverage—plus extras— then Medicare Advantage could be a better choice.
So, which one makes more sense?
This guide breaks it all down to help you make the right choice.
How Original Medicare Works
Original Medicare is a government-backed health insurance program for people 65 and older and some younger individuals with disabilities. It covers hospital stays and medical care, but it’s not a perfect fit for everyone.
Knowing what’s included (and what’s not) can help you determine if it’s the right option for your needs.
What Does Original Medicare Include?
Original Medicare has two main parts:
- Part A (Hospital Insurance): Hospital stays, skilled nursing care, hospice, and some home health services.
- Part B (Medical Insurance): Doctor visits, outpatient care, preventive checkups, and medical equipment like wheelchairs or oxygen supplies.
The biggest advantage is that you’re not restricted to a network. You can see any doctor or specialist across the country as long as they accept Medicare. This is great if you travel often or want the freedom to choose your healthcare providers.
What Will You Pay?
Costs with Original Medicare can add up, so it’s important to know what to expect:
- Part A
- Most people don’t pay a premium for Part A. However, if you have fewer than 40 quarters of Medicare-covered employment, you may need to pay a premium.
- The deductible is $1,676 per benefit period.
- Part B
- The monthly premium is $185.
- The annual deductible is $257.
With Original Medicare, there’s no limit to how much you might pay out of pocket each year. Unlike private insurance, it doesn’t set a maximum on costs. That’s why many people add a Medicare Supplement (Medigap) plan to help cover expenses like copays, coinsurance, and deductibles.
Original Medicare covers a lot, but it doesn’t include routine dental, vision, or hearing care. If you need prescription drug coverage, you’ll have to sign up for a separate Part D plan.
How Medicare Advantage Works
Medicare Advantage (Part C) is a different way to get your Medicare coverage through private insurance companies. Instead of using Original Medicare, you enroll in a Medicare-approved plan that combines hospital, medical, and often prescription drug coverage into one.
Many plans also offer benefits like dental and vision, but there are some trade-offs to consider.
What Does Medicare Include?
Medicare Advantage plans bundle Parts A (hospital) and B (medical) and usually include Part D for prescription drug coverage. These plans are run by private insurance companies and must offer the same basic benefits as Original Medicare—but many go beyond that with extras like:
- Dental, vision, and hearing care
- Gym memberships and wellness programs
- Transportation for medical appointments
One big difference from Original Medicare is that Medicare Advantage plans use provider networks. This means you’ll need to see doctors and hospitals within your plan’s network to get the lowest costs.
If you choose an HMO (Health Maintenance Organization) plan, you’ll likely need referrals and must stay in-network. PPO (Preferred Provider Organization) plans give you more flexibility, but going out-of-network usually means paying higher costs.
How Much Does It Cost?
Medicare Advantage plans often have lower monthly premiums than Original Medicare combined with a Medigap plan. Still, your costs will depend on the plan and provider network. Here’s what to expect:
- Some plans offer $0 monthly premiums, but you’ll still need to pay your Part B premium.
- You’ll have copays and coinsurance for doctor visits, hospital stays, and other services.
- Medicare Advantage includes an annual out-of-pocket maximum, which means once you reach that limit, your plan covers 100% of your costs for the rest of the year—something Original Medicare doesn’t offer.
One downside? If you go outside your plan’s network, you may have to pay more, or the service may not be covered at all. This makes Medicare Advantage a better fit for people who want to use a set network of doctors and hospitals.
Medicare vs. Medicare Advantage: The Biggest Differences
Now that you know how each option works, let’s talk about the biggest differences.
Provider Choice
With Original Medicare, you can see any doctor or hospital in the U.S. that accepts Medicare. It’s a better option if you travel often or want the freedom to choose your own providers without worrying about coverage limits.
Medicare Advantage plans work differently. Most use provider networks, so you’ll need to stick with in-network doctors and hospitals to keep your costs low.
Coverage Differences
Both options cover hospital care (Part A) and medical services (Part B), but they’re not the same when it comes to extra benefits.
With Original Medicare, you’ll need to buy a separate Part D plan if you want prescription drug coverage.
Medicare Advantage plans usually include Part D. It combines hospital, medical, and drug coverage into one plan for added convenience.
Costs and Out-of-Pocket Expenses
One of the biggest differences is how much you’ll pay out of pocket.
With Original Medicare, you pay 20% of most services after meeting your deductible. There’s no yearly cap on what you might spend, which is why many people add a Medigap (Medicare Supplement) plan to help with coinsurance, deductibles, and other costs.
Medicare Advantage plans often have lower monthly premiums, but you’ll pay copays for doctor visits, hospital stays, and other services. However, Medicare Advantage has an annual out-of-pocket maximum. Once you hit that limit, the plan covers 100% of your costs for the rest of the year.
Extra Benefits
Original Medicare covers medically necessary services, but it doesn’t include routine dental, vision, or hearing care. If you need those benefits, you’d have to buy separate coverage.
Many Medicare Advantage plans go beyond basic coverage, offering extras like dental, vision, and hearing care. Some even include gym memberships and wellness programs. These added perks make it better for those looking for more benefits in one plan.
Travel Coverage
Original Medicare gives you nationwide coverage if you travel often or live in different states throughout the year. As long as a doctor or hospital accepts Medicare, you’re covered no matter where you are in the U.S.
Medicare Advantage plans work differently. They’re usually limited to a specific region, so if you go outside your plan’s network, you might have to pay full price for care—unless it’s an emergency.
Conclusion
It all comes down to what matters to you. Do you want the freedom to see any doctor, travel often, or prefer predictable costs with a Medigap plan? Consider Original Medicare.
But if you like the idea of lower monthly premiums, bundled benefits, and extra perks like dental and vision, a Medicare Advantage plan could make more sense.
Not sure where to start? Healthpilot Medicare Simplified helps you compare plans based on your specific needs. You can find the right coverage without the guesswork.
