Posted by RJ McCollam | October 5th, 2021
Medicare Advantage vs. Original Medicare: Which One’s Right for You?
Navigating the world of Medicare can be overwhelming—especially when you’re faced with the decision between Original Medicare and Medicare Advantage. Both options offer health coverage for those 65 and older (or under 65 with certain disabilities), but they differ in structure, costs, and benefits. Understanding the pros and cons of each can help you make the right choice for your health needs, lifestyle, and budget.
Here’s a side-by-side look at Medicare Advantage vs. Original Medicare—and what to consider when choosing the plan that’s right for you.
What Is Original Medicare?
Original Medicare is the traditional, government-run program and includes two parts:
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Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services.
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Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and some medical supplies.
Key Features of Original Medicare:
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You can visit any doctor or hospital in the U.S. that accepts Medicare.
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You usually pay 20% of the Medicare-approved amount for most outpatient services after meeting your Part B deductible.
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It does not include prescription drug coverage—you must enroll in a separate Part D plan for that.
While Original Medicare offers flexibility in choosing healthcare providers, it doesn’t include extras like vision, dental, or hearing coverage.
What Is Medicare Advantage?
Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans bundle Part A and Part B coverage—and often Part D (prescription drug coverage)—into a single plan.
Key Features of Medicare Advantage:
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Many plans include additional benefits such as dental, vision, hearing, and wellness programs.
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You typically pay lower monthly premiums than a Medigap policy, but may have copayments and coinsurance for services.
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Most plans require you to use a network of doctors and hospitals and may need referrals to see specialists.
Medicare Advantage plans work more like an HMO or PPO insurance plan, which can be a benefit or a limitation depending on your healthcare preferences.
Comparing Costs
Original Medicare:
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Monthly premium for Part B (standard amount set by the government).
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20% coinsurance for most services after deductible.
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Optional Part D premium for drug coverage.
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No annual out-of-pocket limit (unless you purchase Medigap insurance).
Medicare Advantage:
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Often has lower monthly premiums.
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Out-of-pocket costs vary by plan but are capped annually.
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Many include prescription drug coverage, eliminating the need for a separate Part D plan.
If you prefer predictable costs and extra benefits, Medicare Advantage might be appealing. However, Original Medicare paired with Medigap could provide broader access to providers and fewer out-of-network concerns.
Provider Access and Flexibility
With Original Medicare, you have the freedom to see any doctor or specialist that accepts Medicare, with no need for referrals. Medicare Advantage plans typically have a defined provider network, and going out of network may result in higher costs or no coverage at all.
If you travel frequently or live in multiple states throughout the year, Original Medicare offers more flexibility. But if you’re comfortable staying within a local network, Medicare Advantage could work just fine.
Prescription Drug Coverage
Original Medicare doesn’t cover most outpatient prescription drugs, which means you’ll need to enroll in a standalone Part D plan. In contrast, most Medicare Advantage plans include Part D coverage, simplifying your coverage under one plan.
However, not all drug plans cover the same medications, so it’s important to review the formulary of any plan you’re considering.
Which One’s Right for You?
Here are a few questions to help you decide:
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Do you value freedom to choose any doctor without referrals? → Consider Original Medicare.
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Do you want coverage for vision, dental, or hearing? → Medicare Advantage may be a better fit.
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Are you concerned about high out-of-pocket costs? → Medicare Advantage has annual limits, while Original Medicare does not.
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Do you frequently travel or split your time between different states? → Original Medicare offers more nationwide flexibility.
Everyone’s situation is different. Your health needs, preferred doctors, and financial goals all play a role in determining the best fit.
Choosing between Medicare Advantage and Original Medicare is a personal decision—and one that deserves careful consideration. Each option has its own advantages, depending on how you want your healthcare managed and what coverage matters most to you.
If you’re unsure where to start or want help comparing plans, consulting with a licensed Medicare insurance specialist can provide personalized guidance and ensure you enroll in the plan that aligns with your needs. The right coverage can offer peace of mind, lower costs, and access to the care you need—when and where you need it.