As a senior, what should I know about the differences between Original Medicare and Medicare Advantage before I choose?

Question

Comfort Olude · Accepted Answer

Basic Original Medicare by itself covers Part A (hospital stays) and Part B 
( doctor visits). You usually pay a monthly Part B premium, which is paid by Social Security Administration from your benefits, and you must meet yearly deductibles. Original Medicare will then cover 80% of the approved amount, and you're responsible for the remaining 20% of the cost of care. There is no limit to your out-of-pocket cost each year. You may need a supplemental insurance plan to cover 20% of the cost of care and prescription drug coverage.

Medicare Advantage plans are more comprehensive plans that support your entire well-being, so you can live a better, healthier life. You usually pay a monthly Part B premium, which is paid by Social Security from your benefits. 
In one package, it gives you Part A and Part B coverage, plus Part C coverage.
Many plans also include Part D prescription drug coverage. It has limited out-of-pocket cost, It has more predictable co-pays, and a cap to your yearly out-of-pocket expenses.

Larry Dalton · Answer

You can always convert your Medicare Insurance plan from the traditional or original Medicare coverage with a supplemental plan to a Medicare Advantage plan "at any time" throughout your life, regardless of your health conditions.  

However, converting back from a Medicare Advantage plan to the original Medicare A & B with a Medicare supplemental plan could present a significant problem.  Why?  After passing up the special exemptions period (known to some as the Golden Opportunity), with Medicare supplement plans, then the insurance companies have the right to evaluate your healthcare conditions before accepting you into one of their Medicare supplemental or Medigap plans.     Health examinations or health questions are not utilized to determine the approval of a Medicare Advantage plan.

Norman Smith · Answer

The most important questions to ask yourself are these:

1) - As I age, will my health get better or worse?
2) - How important is it for you and your family to have the election of any doctor or facility in the USA?
3) - How important is it to be in control of your own health, as opposed to a private company making decisions for you?

If the answer to the first one was anything other than "worse", you are fooling yourself.
 
And if the last 2 aren't important to you at all, and you are fine with staying in a network of chosen health professionals that may or may not be top in their field, you are happy getting referrals from the PCP you are allowed to see - to see specialists, etc., and are focused on the "freebies" an MA plan can give you, then you should take one of their plans. Otherwise, Original Medicare with a proper supplement plan is the best choice.

Terri Reagin · Answer

The biggest difference between the two is that Original Medicare has no out of pocket maximum. This means that the 20% has no cap to it should you be diagnosed with something serious. By law Medicare advantage must cover as good as or better than Original Medicare so you don't have to worry about "Losing" benefits by going to an advantage plan but you will have networks to contend with that Original Medicare doesn't have.

Answered by Terri Reagin on August 18, 2025

Broker Licensed in OK, AR, CO & 6 other states

Answered by Terri Reagin Medicare Insurance Agent

William Gray · Answer

Original Medicare is a point of service plan you do not have to choose a network provider and can go to any doctor who accepts Medicare. 

With a supplement to Medicare you can reduce your liability to a few hundred dollars per year. 

These plans will have a premium.

Medicare part C "Advantage" plans are Medicare replacement plans.

You will likely need to use network doctors to receive the best rates or to be covered at all.

There are more significant copays and out of pocket limits.  But many plans have zero additional premium.

Randall Taylor · Answer

You need a consultation with a qualified Medicare Specialist. There's a lot of information and can be confusing if you try to do this on your own.

Tai Thao · Answer

Original Medicare has no network, 20% gap, no Dental, Vision or hearing. Medicare advantage has limited network, extra benefits like Dental, vision and Hearing. Some also come with OTC and gym membership.

Answered by Tai Thao on June 23, 2025

Broker Licensed in WI, AR, NC & OK

Answered by Tai Thao Medicare Insurance Agent

Sean Willingham · Answer

Original Medicare vs Medicare Advantage is the most important decision that you will make about Medicare. In short, Original Medicare is best suited for people that want to maintain the most control over where they go for their medical care because Original Medicare has no network. With Original Medicare you can go to any provider that takes Medicare without needing a referral. Medicare Advantage plans package together hospital, medical, prescription drug, and usually additional benefits like dental, vision and hearing. In my opinion, Medicare Advantage plans are best suited for individuals that are seeking the best bargain on their health plan. For an in-depth analysis, it is best to have a conversation with a licensed insurance agent.

Answered by Sean Willingham on June 17, 2025

Broker Licensed in TX, AL, FL & 8 other states

Answered by Sean Willingham Medicare Insurance Agent

Daniel Weeks · Answer

With Original Medicare and Medigap Supplement, you get a Medicare Network.  Meaning you can go anywhere in the country Medicare is accepted without any referrals.  The Medigap Supplement is guaranteed renewable for life.  As long as you pay the premium, your plan and benefits are guaranteed to never change or go away. With Original Medicare, you get to choose your specific drug coverage.  You can choose any stand-a-long drug plan available in your area.

With Advantage plans, they run like an HM)/PPO (like your old employer insurance).  The doctor or clinic has to accept your specific plans benefits terms and rates.  Advantage plans are annually renewable.  They can and in some ways do change every year.  They can drop you as an individual though.  They drug plan is included in the Advantage plan benefits.  So there is no customization in choosing your drug plan.

Marye Carr · Answer

Original Medicare - Part A helps pay for hospital stays and inpatient care; Part B helps pay for doctor visits and outpatient care, only.

OM pays 80% - leaving 20% for you to pay.  Plus you will need a drug plan, dental plan, hearing, and vision plans, all comes with monthly premiums, which can really add up.

Medicare Advantage Plan(Part C) - Combines Part A(hospital) and Part B (doctor) with Part D (drugs) into one plan.  Some offer add'l benefits like, dental, vision & hearing and more. Some have $0 monthly plan premium and other have low monthly premium.

Michael Wehner · Answer

Original Medicare, which consists of Part A (Hospital) and Part B Medical, Outpatient) does not cover everything and does not address prescription drug coverage. Original Medicare covers 80% of outpatient services with no out of pocket limit and limits the number of lifetime days in the hospital. Medicare Advantage is one of the options that people choose to help cover things that Original Medicare does not. Medicare Advantage plans cover everything that is included in Original Medicare and many times covers additional things. You can get Medicare Advantage plans that include prescription drugs. Also, Medicare Advantage plans will have a maximum out of pocket for medical expenses that doesn't exist with Original Medicare. Many Medicare Advantage plans will also include extra benefits like dental, vision and hearing as well as Over the Counter items (vitamins and basic medical supplies).

Answered by Michael Wehner on August 18, 2025

Agent Licensed in IN, KY, NC, OH, PA & SC

Answered by Michael Wehner Medicare Insurance Agent

Steven Bleicher · Answer

If there is an adult educational division at a local university or a non-profit through your county who offers a Medicare course, it would surely be worth knowing that Part A (Inpatient Hospital admission) and Part B (anything Outpatient like a free-standing surgical center or lab), while Part C is an Advantage plan, either with or without drug coverage while a Part D(rug) plan is called a “Stand-Alone” Rx plan strictly covering all prescribed (both generic & brand name) Rx's. There are many quirky aspects to Medicare so your answer is a resounding YES!

Answered by Steven Bleicher on June 3, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Steve Houchens · Answer

You should absolutely know both and understand all your options before making a choice. There are many differences and you should talk with someone that will explain all options to you.

Dana Dane · Answer

I would call an agent and meet face to face if you can.  They can educate you on the plans available in your area and find out what type of plan would be best for you.

Chad Watkins · Answer

Original Medicare has large deductibles and copays so it helps to supplement that with either a Medicare Advantage or Medicare supplement plan. It is important to know that most Medicare Advantage plans will require you to deal with doctors and hospitals that are in network to pay the least in copays.

Answered by Chad Watkins on May 14, 2025

Agent Licensed in NJ, AK, AL & 48 other states

Answered by Chad Watkins Medicare Insurance Agent

Cleo Martin · Answer

With Original Medicare you pay a premium each month. Then depending on the plan you pay the deductible. After deductible is paid then Medicare pays it part and the supplement pays the rest of what is owed. There are NO networks for doctors or hospitals, so you can go to whoever you want without a referral.  Now the premium on Medicare supplement can go up each year as you get older but as long as you pay the premium you can't be canceled. There is no dental or Hearing benefits, and no silver sneakers.  With Medicare Advantage it is managed care by insurance companies.  Usually there is no premium but a cost everything you use it. Be it a specialist, trays, MRI's? hospitals. There is maximum out of pocket you would pay each year. Your doctors and hospitals need to be in their network. They do give you dental, vision, hearing and some other benefits. Drug benefits are included with MA, you have to buy a separate drug card with original Medicare.  These are some of major differences.

Cleo Martin

Mal Varlack · Answer

Original Medicare can be used anywhere in the US, while Medicare Advantage is limited to networks. Drugs are NOT included with Original Medicare, while Medicare Advantage in many plans DO include drugs. Original Medicare means you still need to get a Medigap Plan because without you are subject to 20% coinsurance on use of the plan with NO limit to the out of pocket. Medicare Advantage has a maximum out of pocket These are some of the things that are differences to know but there are more

Answered by Mal Varlack on August 17, 2025

Agent Licensed in FL

Answered by Mal Varlack Medicare Insurance Agent

Cathy Barnett · Answer

Medicare Advantage will not only save in deductibles but will give extra benefits like dental, vision and hearing

Vachik Chakhbazian · Answer

Original Medicare (Parts A & B) offers broad coverage, but may require supplemental coverage like Medigap or Part D, and has no out-of-pocket maximum. Medicare Advantage (Part C) plans are offered by private companies, often include prescription drug coverage and extra benefits like dental or vision, but can limit your choice of doctors and require prior authorization for some services.

Answered by Vachik Chakhbazian on July 24, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Mike Henry · Answer

Basically a lot of things. Which makes more sense. What fits into my budget the best. Are my Dr and hospital in it

Carol Thompson · Answer

The cost off  Part B, co- payments, co- insurance and cost sharing of plans. Rates can go up each year as plan can change.

Todd Bostic · Answer

Original Medicare only pays 80% of your costs for Hospital and Doctors unless you have a Medigap plan. It doesn’t have any benefits like Dental, Vision, or Hearing either, you have to purchase that along with a prescription drug plan. MAPD plans have all of that included, but you have a copay for most services in most plans. Basically a Medigap plan is like a prepaid plan that gives you gold treatment. A MAPD plan is pay as you go. If you don’t use it you don’t spend much if anything.

Answered by Todd Bostic on June 23, 2025

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Gary Haft · Answer

Understand that a Medicare Advantage Plan has a network of providers they expect you to use whereas Original Medicare and a Medicare Supplement allows you to go to any doctor or hospital or medical facility in the USA as long as they work with Medicare. There are many restrictions on a Medicare Advantage Plan and you have to follow their rules and stay within their network of providers. With Original Medicare and having a Medicare Supplement - you have freedom of choice to see anyone of your choosing.

Answered by Gary Haft on July 7, 2025

Agent Licensed in FL, AL, DC & 9 other states

Answered by Gary Haft Medicare Insurance Agent

Sandy Hammond · Answer

Original Medicare Parts A & B lets you see any doctor or hospital in the U.S. that accepts Medicare.  You can add a Part D drug plan and optional Medigap coverage for predictable costs, and to help cover some of the costs that Original Parts A & B.   Medigap plans generally do not include dental, vision, or hearing benefits. 

Medicare Advantage bundles hospital, medical, and usually drug coverage—often with extra benefits—but limits you to plan networks, may require referrals, and benefits can change each year. Your choice depends on whether you value broad provider access and stable benefits or lower premiums and added extras within a network.

Natalee Nimmo · Answer

That is gonna depend on where you live if you have Medicare or Medicare & Medicaid, plus it’s also going to depend on the Medicare Advantage carrier and the plan that you’re considering. This is not a quick answer type of question. This is the type of question you wanna ask a broker or agent about and let them pull up The information on whatever plan you’re looking at and give you the differences between the two from there.

On the surface, I can say that networks is a big difference. Medicare advantage has networks Medicare supplement does not. Prior authorizations is a big difference, Medicare advantage has prior authorizations, and Medicare and Medicare supplement does not. Understand that with Medicare advantage plans, the doctors and hospitals can decide in the middle of the year or basically at any time of the year, that they no longer wanna take that plan anymore. With original Medicare and a Medicare supplement that does not happen. Another big difference is going to be co-pays, deductibles and Max out-of-pocket amounts.

Robert Barco · Answer

Original Medicare is insurance provided by the Medicare system. This insurance is Medicare Part A, hospital coverage, and Part B, outpatient services. Additionally, you need Part D stand-alone prescription drug coverage or move to the alternative Medicare Advantage all-in-one plan. Medicare Advantage is provided by private insurance companies that have a contract with the Medicare system.

Answered by Robert Barco on May 2, 2025

Broker Licensed in OH

Answered by Robert Barco Medicare Insurance Agent

Maci Mishler · Answer

You should understand the difference in network accessibility as well as the difference between prior authorizations and who is making the decisions about whether the insurance will pay or not. Seek out a good broker!!

Answered by Maci Mishler on June 9, 2025

Broker Licensed in NE, AR, KS & MO, ND, OK & TX

Answered by Maci Mishler Medicare Insurance Agent

Calvin Hodge · Answer

The major difference that you should know is with original Medicare you can see any doctor that accepts Medicare. With the Medicare advantage, it takes a little more planning because Medicare, advantage companies have a network and it is most beneficial to stay in the network

The other major difference is original. Medicare is the government program where a Medicare advantage plan is a private. This company, who stands in place of original medicare, and must provide at least as good coverage as a original medicare. 

The last and perhaps most important difference is that with the original medicare, there is no limit to your liability. However, with an advantage plan, there is a "maximum out of pocket cost" which sets an upper limit to how much you might have to pay in a year.

Vincent Gatewood · Answer

Medicare is made up of two parts. Part A and part B. Part A pay 80% of your hospitalization bill and part B pay 80% of your doctor bills. You need a supplement to pay the 20% of the two bills.

Medicare advantage plans offer to pay your hospital and your doctor bill at 100%. you may have a deductible, co-pay or meet an out-of-pocket, depend on the plan. Addition to your plan, they may offer eye plans, hearing and prescription drug plan.

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