Original Medicare vs. Medicare Advantage: What’s the Difference?
When it’s time to choose your Medicare coverage, one of the biggest decisions is whether to stick with Original Medicare or enroll in a Medicare Advantage plan. Both options offer important benefits, but they work in different ways. Understanding how they compare can help you decide which type of coverage best fits your health needs and budget.
What Is Original Medicare?
Original Medicare is the traditional program run by the federal government.
It includes:
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Medicare Part A (Hospital Insurance): covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
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Medicare Part B (Medical Insurance): covers doctor visits, outpatient care, preventive services, lab tests, and durable medical equipment.
With Original Medicare:
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You can see any doctor or hospital in the U.S. that accepts Medicare.
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There’s no network—you have broad freedom of choice.
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Prescription drugs are not included. To get drug coverage, you need to add a Part D plan.
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Many people also choose a Medicare Supplement (Medigap) policy to help pay deductibles, copayments, and coinsurance.
What Is Medicare Advantage?
Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans combine your Part A and Part B benefits—and often include extras.
With Medicare Advantage:
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Most plans include prescription drug coverage (Part D).
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You may also get added benefits like dental, vision, hearing, and wellness programs.
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Costs are usually structured with copayments, coinsurance, and an annual out-of-pocket maximum.
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Plans often use provider networks (like HMOs or PPOs), which may limit your choice of doctors and hospitals.
Key Differences Between Original Medicare and Medicare Advantage
Feature | Original Medicare | Medicare Advantage |
|---|---|---|
Portability | Nationwide coverage | Typically regional or network-based |
Costs | 20% coinsurance with no out-of-pocket maximum | Copays, coinsurance, and an out-of-pocket maximum |
Extra Benefits | Not included (Medigap helps with costs, but no dental/vision) | Often includes dental, vision, hearing, wellness |
Prescription Drugs | Requires separate Part D plan | Often included |
Provider Choice | Any doctor/hospital that accepts Medicare | Usually limited to plan’s network |
Coverage | Part A + Part B | Part A + Part B (often includes Part D and extras) |
Which Option Is Right for You?
The choice between Original Medicare and Medicare Advantage depends on:
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How often you visit doctors or specialists
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Whether you want nationwide provider access or don’t mind a network
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Your prescription drug needs
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Whether you value extra benefits like dental and vision
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How much financial protection you want from out-of-pocket costs
Need Help Deciding?
Medicare isn’t one-size-fits-all. As a licensed independent insurance broker, I can help you compare Original Medicare and Medicare Advantage plans side by side, explain the costs, and find coverage that works best for your lifestyle and budget.