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.

Gary Church · Answer

Choice! Do you want to have full control of your healthcare or let the insurance company manage your care? Affordability is also very important when deciding which way to lean. I would recommend meeting with a licensed Medicare agent to review all your options.

Answered by Gary Church on September 7, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Mike Alexander · Answer

On Traditional Medicare you can go to any hospital or Foctor that takes medicare.
On advantage plans, you must use network providers in order to have lowest cost.

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.

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.

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

Pamela Masters · Answer

The biggest difference is that with Medicare advantage you have a plan that typically covers medical part A and B and part D for your drugs. They also can cover vision, dental and hearing as well as other benefits that may be added. You also don’t typically have deductibles for your medical side. 
Original Medicare only pays for part A, hospital, and part B outpatient.  You also have deductibles for both part A and part B.

Jacqueline Proffit · Answer

Choosing between Original Medicare and Medicare Advantage (also known as Part C) is a big decision for seniors. The main difference is who provides your coverage: the federal government for Original Medicare, or a private insurance company for Medicare Advantage.
Key Considerations for Your Choice:

Cost and Financial Risk: If you prefer a lower monthly premium and don't mind paying co-pays and co-insurance as you go, and want a maximum out-of-pocket limit, a Medicare Advantage plan might appeal to you. If you prefer a higher monthly premium but very little out-of-pocket cost when you receive care, Original Medicare plus a Medigap plan offers that (though you cannot have Medigap with Medicare Advantage).   

Flexibility and Travel: If you want the freedom to see any doctor or specialist in the U.S. who accepts Medicare without a referral, Original Medicare is the better choice. If you are comfortable staying within a specific network and service area, Medicare Advantage could work for you.   

Health Needs: If you anticipate needing a lot of medical care, having the predictability of a Medigap plan with Original Medicare, or the annual cap on out-of-pocket costs with Medicare Advantage, can be very important.

Kelsey Hentzen · Answer

With Original Medicare, if you have to go into the hospital, your Part A has a $1736 deductible per benefit period. This means, with each hospital admission if you go in again after 60 consecutive days outside a hospital or skilled nursing facility, you might pay it multiple times in a year for different hospital stays. Additionally, part B has a $288 annual deductible and a 20% coinsurance. When you add an advantage plan with your original Medicare, you may pay $350-$450 per hospital stay days 1-7 and $0 copay thereafter. On an advantage plan, you have a max out of pocket so you know in a calendar year, you will not exceed that amount. With original Medicare, your 20% coinsurance has no maximum.

Answered by Kelsey Hentzen on January 20, 2026

Broker Licensed in KS & MO

Answered by Kelsey Hentzen 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.

Kerwyn Jones · Answer

Original A&B cover 80% of your medical cost. You need a Supplement to cover the other 20% and a Stand Alone Drug Plan.

Medicare Advantage includes Part A, B & D. 

There is so much more.

Edward MacConnell · Answer

There are many differences from every angke, premium, coverage and so much more. The best advice is to find an independent professional to assist you in the process.

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.

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

Mary Green · Answer

The most important thing to know is who is administering your Medicare benefits. If you have original Medicare, the government is administering your healthcare. If you're enrolled in a Medicare Advantage plan, a private insurance company is administering your Medicare benefits. They have to offer at least the same benefits as original Medicare and follow Medicare rules and regulations, but they may have some of their own rules and some of their own benefits as well. Look those plans over carefully before you choose.

Answered by Mary Green on October 22, 2025

Broker Licensed in AL, CO, FL, GA, TN & VA

Answered by Mary Green Medicare Insurance Agent

Jay Larshus · Answer

Original Medicare does not have a Network of Physicians and Clinics. Thus, you may go to any provider that accepts Medicare. Medicare Advantage plans will have a Network of Physicians and Clinics. Some providers may not be in your Network. However, many Advantage plans do include Rx, Vision, Dental, and Hearing Coverage. Some Advantage plans may also have Free Over the Counter benefits.

Answered by Jay Larshus on March 2, 2026

Agent Licensed in TN & VA

Answered by Jay Larshus Medicare Insurance Agent

Charles Calvin · Answer

The main thing to know is that Medicare Advantage, by law, has to offer coverage as good as or better than Medicare; meaning you won’t lose out on anything by having a Medicare Advantage plan. Beyond that, it comes down to how you want services covered, and how much you want them to cost, as well as what benefits are important to you. There are too many nuances to cover here, but Advantage plans often give you extra benefits that Medicare doesn’t, as well as including Part D prescription coverage. Original Medicare with a Supplement (also known as Medigap) will cover nearly everything, but will not give you the extras of an Advantage plan, nor does it include Part D, which has to be gotten separately for (in most cases) an additional cost. Which direction to go is best determined by a careful analysis of each individual’s situation, which we as brokers are equipped to do.

Answered by Charles Calvin on February 27, 2026

Broker Licensed in MO, FL, IA, IL, KY & SC

Answered by Charles Calvin Medicare Insurance Agent

Kim Cotten · Answer

You should know the differences because choosing the wrong plan for your needs can cost you time, money, and peace of mind. Understanding the differences helps you choose the plan that matches your lifestyle, health needs, and budget. It ensures you aren’t stuck with unexpected bills or limited access when you need care the most.

Answered by Kim Cotten on April 1, 2026

Broker Licensed in FL, AL, CA & 12 other states

Answered by Kim Cotten Medicare Insurance Agent

Joshua Allen · 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 Joshua Allen on June 17, 2025

Broker Licensed in TX, AL, AZ & 20 other states

Answered by Joshua Allen Medicare Insurance Agent

Mike Cooper · Answer

As an Agent, I try to remain neutral as to my own preferences between Original Medicare and Medicare Advantage.  That said, there are some critical details which really need to be shared.

Network:
Original Medicare has Medicare's largest network... comprising around 98% of doctors and hospitals in the nation.  Some of the Top Tier providers, like Mayo, John C Hopkins, Scripts... and a growing number of others do NOT accept Medicare Advantage plans.

Approval:
For some time now, Medicare Advantage plans have been developing a reputation (a bit behind the scenes) for NOT approving procedures and surgeries.  Your doctor submits an approval request... and a large number of those requests are being denied ("In 2023, insurers fully or partially denied 3.2 million prior authorization requests...").  

A friend's (and fellow agent's) mom started into Medicare with an Advantage plan.  Her doctor's requests for an MRI were declined twice!  Her Agent/son was still able to move her over to an Original Medicare plan... and $100's of thousands of dollars later, (PRAISE God!!) she is now cancer FREE!  Her portion?  Less than $250.

As an Agent, your Choice is your Own... AND... you need to know the Playing Field.  

Some Agents are extremely biased in how they steer their clients.  I know of Agents that have 95% of their clients in Original Medicare... while other Agents have 95% Medicare Advantage plans.  Make sure your Agent's bias is your Preference... NOT theirs. 

Blessings-
Mike

Kent Hoyle · Answer

In my professional opinion as a Broker and beneficiary, if you wish to give the insurance companies the advantage, write a Medicare Advantage Policy. Why do I say that, because it is the insurance company and only the insurance company that will adjudicate your claim. To prove my point, during the Annual Election Period, 10/15 - 12/7 each year, watch the very expensive TV commercials. Almost all of the advertisements are encouraging beneficiaries to write Medicare Advantage Policy policies. Do you think for a minute the companies are going to encourage you to write policies that will cost them money or those that are most lucrative for them? Whereas with Original Medicare the claims are adjudicated by the Center for Medicare.

Reasons to select Original Medicare and a Medicare Supplement policy.

Only Medicare Supplement policies are Guaranteed renewable for Life. None of the Medicare Advantage policies are written as such.

Only with Medicare Supplement policies can you alone select all your Healthcare providers whenever and wherever you choose throughout the entire United States. No PPO’s or HMO’s.

If you move to another part of the country, your Medicare Supplement policies goes with you. This may not be true of the Medicare Advantage policies which can sometimes even be accepted only in certain countries.

Granted there are many other positive as well as negative features with both choices. Do your own do diligence and follow your own gut feeling.

Rebecca Davis · Answer

There are lots of things to know but 2 very specific ones is that original Medicare does not have a max out of pocket on part B so no matter the size of the bill you will owe 20% over and over again, where a Medicare Advantage plan does have a max out of pocket, so once you hit that the plans covers you at a 100% for the rest of the year as long as its medically necessary, and approved by the plan.

The other thing I would say is how networks work. Original Medicare uses the Medicare network so as long as the doctor or the hospital etc take Medicare they will accept your original Medicare card and you don't need a referral. With a Medicare Advantage plan, you have to use the specific carrier's network, they have PPO's, HMO's and more but those are the 2 main ones. The doctors must take the plan with an HMO no exception and with a PPO they must be willing to bill it. If your doctors don't take the plan then you will have to pay the bill yourself, so always make sure your doctors are covered.

There is a laundry list of things you need to know, you can reach out at any time.

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.

Gabriel Reinhardt · Answer

Great question- there are many significant differences. When you are on Original Medicare you can see any doctor in the nation who accepts Medicare (and new patients). When you are on an Advantage plan, you choose a provider who accepts the plan. Some plans have large networks, and some plans do not. 
Advantage plans do have many benefits one doesn’t get from original Medicare. They are called “extra benefits”. These may include things such as routine and major dental, eye exams and vision allowance, hearing exam and aids allowance, and gum memberships, to name a few. A great thing they offer is max out of pocket protection, similar to work group plans, if you’re familiar. In Original Medicare there is no max out of pocket protection. (Let me know if you want to talk about supplements which help with your out of pocket costs.)
Lastly, there are some advantage plans that reduce your part b premium payment. I advise anyone considering these options to carefully  add up a typical year’s usage to see if it makes sense. There’s so much more, but these are a few things that so how different they can be. Please let me know if you’d like to go into more depth for your situation and needs. It’s unique for everyone!

Nick Harris · Answer

What you need to know is that with Original Medicare you need not worry about provider networks or the insurance company “authorizing” treatment. Those are the two main things I see that scare folks away from Medicare Advantage Plans (Part C).

With that said, Original Medicare only includes Hospital (Part A) and Medical (Part B) and it covers 80% of the bill, leaving you with 20% and no maximum out of pocket (NO CEILING ON COSTS).

If you want to keep original Medicare you should probably get a Medigap Plan (also known as a Supplement) that covers the remaining 20% that Original Medicare doesn’t.

I have the majority of my clients on Medicare Advantage due to affordability and weighing out the pros and cons for their individual situation and financial position.

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.

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

Andrew Zurbuch, MBA · Answer

Original Medicare was established in 1965 and is  generally 80% coverage. It works like a private fee for service, PFFS, and the same coverage in nationally. Medicare Advantage in contrast was established in approximately 2006 and is private health insurance through an Insurance Company that markets and sells it's plan or plans. This Insurance Company selects what State or States to offer their Medicare Advantage plan or plans in and these are 1 year coverages. 

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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.

Jim Tretola · Answer

You should know that a Medicare Advantage Plan, by Law, covers all that Original Medicare Part A & Part B cover, with the main benefit of covering the 20% that is not covered by Part B. There are many factors to consider, which should be discussed with a Licensed Broker.

Answered by Jim Tretola on October 4, 2025

Broker Licensed in NJ, CA, CT & 6 other states

Answered by Jim Tretola Medicare Insurance Agent

Priscilla Ramos · Answer

Original Medicare
•	You can see any doctor that takes Medicare
•	No networks, no referrals
•	Higher monthly cost, but fewer surprise bills
•	Good if you travel or want freedom to choose doctors
Medicare Advantage
•	You use a network of doctors
•	Often low or $0 monthly premium
•	Includes extras like dental and vision (limited)
•	You pay copays when you use care
If you have Medicaid as well, that will make a difference because then you will be eligible for a Medicare advantage dual plan which can cover a lot more depending on the level of Medicaid you have.

Kris Moen · Answer

Original Medicare with a supplement is like paying ahead so nothing surprises you.
Advantage is cheaper each month, but you’re playing by the plan’s rules when you use it.

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

Barbara Patterson, CFP · Answer

Original Medicare does not have a network where you have to get referrals like you do on a Medicare Advantage HMO. Original Medicare is often supplemented with a Medicare Supplement that has a monthly premium and you can have a small deductible of $283/year and $0 out of pocket after and drug copays.

Answered by Barbara Patterson, CFP on January 26, 2026

Agent Licensed in TX

Answered by Barbara Patterson, CFP Medicare Insurance Agent

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

Broker Licensed in FL, AZ, GA & 11 other states

Answered by Mal Varlack Medicare Insurance Agent

Jeffrey Greenberg · Answer

Original medicare allows you to use ANY DR in the country who accepts MEDICARE. Advantage plans have networks and pre certification provisions.

Kathy Detweiler · Answer

Original Medicare parts A  covers your hospital charges at 80 percent, leaving you responsible for the other 20 with no cap. Same with part B, your medical is covered 80 percent, with you left with the 20 percent. 
You also must have part D, prescription drug plan
Dental, hearing, and vision would be a separate insurance.
It allows you to see any doctor or go to any facility that accepts medicare. 

Medicare Advantage has co-pays and deductibles but with usually little or no premium. Your prescription drug plan is included along with dental, hearing and vision.
There are networks for your doctors and facilities.

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

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

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.

Mark Boone · Answer

Original Medicare (Part A and B)
Covers hospital stays and medical services like doctor visits and outpatient care. 
You can see any doctor or specialist who accepts Medicare. 
Includes deductibles, copayments, and coinsurance, and there is no annual out-of-pocket maximum limit. 
Does not include prescription drug coverage; you must purchase a separate Part D plan. 
Does not cover extra benefits like routine vision, dental, or hearing care. 

Medicare Advantage (Part C)
Bundles Part A, Part B, and often Part D (prescription drugs) into a single plan, plus additional benefits. 
You typically must use doctors and hospitals within the plan's network. 
May include a monthly premium in addition to the Part B premium. Has an out-of-pocket maximum for Part A and B services, which limits your yearly spending on those costs. 
Usually includes prescription drug coverage (known as an MAPD plan). 
Often includes coverage for things like routine vision, hearing, and dental care, fitness programs, and transportation to appointments.

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

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

Jack Mayer · Answer

Original Medicare is A, B and D this is a supplement to Medicare and you would pay a monthly premium for both the supplement and for Part D. There is no network and you manage your own healthcare. Medicare Advantage is A, B and D but called Part C and the is the managed healthcare model where you are assigned a primary doctor and you are part if an in network HMO health plan. Typically there are no premiums.

Answered by Jack Mayer on January 19, 2026

Agent Licensed in CA & NV

Answered by Jack Mayer Medicare Insurance Agent

Andrew Kelly · Answer

Original Medicare with a Medigap Supplement provides you with the best/most coverage, with the most flexibility, with a fixed cost (Medigap monthly premium), which allows you to appropriately predict and budget your medical costs for the year.

Original Medicare is accepted at any doctor/hospital in America who deals with Medicare. You don't need to worry about "networks" or having your insurance accepted/rejected.

As a working agent in my mid-50's, when I'm Medicare age, I'll definitely be an Original Medicare with Medigap supplement guy!

Rodolfo Rojas · Answer

Original Medicare is Part A and Part B. You also have to acquire a Part D prescriptions.
Original Medicare is an 80/20 system. You can also purchase Medicare supplement-MediGap, which covers what original Medicare does not cover. 
Medicare Advantage has all the plans. It is more affordable, and your coverages are done through the insurance you have. It has to have certain coverages that the government says they have to cover. 
There are Medicare Advantage HMO and PPO. 
Advantage also has a cap to prescription Max Out Pocket; for 2026, it is $2100.00. 
They also have an MOOP for the medical services in the plan, which would mean once you get that amount, you don't have to pay for certain services included in the plan.
Contact me.
Rudy Rojas

Adam Ernst · Answer

There is a lot of information in there to know before making any decision. A personal agent would go over with you the costs of A/B with premiums and deductibles, show you the difference of care between Medicare and then Med Adv. Original Medicare has no networks, along with Medicare Supplements, while Medicare Advantage has networks (PPO, HMO) that you will have to stay in to get the in network coverage. If you choose Original Medicare, you would then need to know about Part D Prescription Drug coverage as this is a required plan you need to have that has a small premium deducted from your Social Security. Medicare Advantage plans have their own prescription drug cover within your plan, along with dental, vision, hearing. With Original Medicare/Medigap, you would need to get your own private dental coverage, as Medicare will only cover what is medically necessary. There are a few others, but that is why it is important to contact a personal agent so they can help simplify this for you.

Answered by Adam Ernst on December 8, 2025

Agent Licensed in NC, SC & TN

Answered by Adam Ernst Medicare Insurance Agent

Charles Borg · Answer

Medicare has no special list of doctors. You can go to almost anyone you want without a referral. Advantage plans have a limited list of participating doctors and you need a referral to see a specialist.

Answered by Charles Borg on April 6, 2026

Agent Licensed in FL & NY

Answered by Charles Borg 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

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 Evans · Answer

Original Medicare covers hospitalization which is Parr A and doctors visit which is Part B. However, an advantage plan will also cover those and extra benefits such as, routine eye, exam physicals, and hearing exam and some even offered a gym membership basic and the price is upfront as to what you will pay

Answered by Robert Evans on December 8, 2025

Agent Licensed in TX

Answered by Robert Evans Medicare Insurance Agent

Thermon Holliday · Answer

Interestingly, this question is rarely asked.  I often wonder why?  This would be the first question I'd want answered!  

The answer is simple, money/costs that simple.  If you plan to rely on Original Medicare only, you will have an unlimited financial risk.  Some may point to the 20% as a capped amount.  However, the true issue is 20% of what number?  20% of $100.00 ok, but 20% of $100,000.00 is much different.  

Medicare Advantage plans have a true Hard Cap.  Once you reach the predesignated max out-of-pocket (MOOP), that is it.  Your financial responsibility has ended.  

For details and comparisons, contact us.

William Wheatley · Answer

Original Medicare is made up of separate parts. Part A is for Hospital coverage and used to be referred to by many Seniors as the Hospital plan. PART B is more for Outpatient services like Doctor office visits. You still have deductibles and are responsible for co-pays and other out-of-pocket costs. Medicare Advantage MA and Medicare Advantage Prescription Drug Plan MAPD are managed by approved private health care carriers and include, if you choose, prescription drug plans and often with $0 Co-pays, etc. Both Medicare Parts A and B, as well as Medicare Advantage plans, have many ways of meeting your specific needs. Some prefer Medicare Parts A and B with supplements, or what are called medigap plans, to help cover the gaps in coverage and money out of your pocket. Others like the all-in-one Medicare Advantage with Doctors, Hospital, and Prescription coverage in a network of providers, all included in that network. Which one is better? That is up to you, and you will have to decide based on your specific individual health assessment. We look forward to providing the information to help you make an informed choice.

Answered by William Wheatley on November 3, 2025

Agent Licensed in MD

Answered by William Wheatley Medicare Insurance Agent

Alyssa Gonzales · Answer

The question is, as a senior, what should I know about the differences between original Medicare and Medicare Advantage before I choose? So that's a loaded question, but I'm gonna try to break it down quickly.

Original Medicare is going to be Part A and Part B as your primary insurance. So that's that red, white, and blue card that says Part A and Part B. Normally, you will have a Medicare supplement, also known as a Medigap plan, as a secondary, sort of like a backup. So they're gonna build your primary, which is original Medicare, then build your secondary. And that's usually the way it goes in terms of creating a holistic hospital and medical plan, a primary and secondary.

Now, because you have original Medicare as your primary, you're not working within the confines of an actual insurance company. You don't have networks. You don't have the things like you would have on the Medicare Advantage side, right? So this is the opposite side of the road. Medicare Advantage does replace original Medicare, so you will be working from a company's HMO or PPO plan. It's just another managed care plan that follows the Medicare rule book.

I can go in-depth about this, but to keep it short, that is the difference. Medicare Advantage, also known as Part C, is a managed care plan that comes in the form of HMO or PPO plans. And then you've got original Medicare, which is Part A and Part B, normally served up with a Medicare supplement as a secondary. Good luck!

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.

Elliot Andrews · Answer

Original Medicare consists of parts A & B.  Part A covers Hospital and Part B covers Medical (doctors visits).  These both have deductibles that change every year before kicking in with a 20% coinsurance for all related claims.  With no additional coverage outside of A & B you are responsible for that 20% with no maximum limit.  Part A has no premium and Part B carries a premium (currently right around $204/month)

You would typically want to consider Prescription drug coverage (even minimal amounts to avoid a penalty in the future), a supplement plan to cover the 20% co-insurance, and possibly a Dental, Vision, Hearing plan to cover non-medical costs.  All of these typically carry a premium and their own deductibles.

Medicare Advantage combines your A and B, and typically, dental, vision, hearing, and prescription drug coverage all into one single plan.  These plans are usually $0 premium (you only pay the Part B premium that Medicare requires - though some Medicare Advantage plans help reduce that cost).  These plans have various co-pays or co-insurance for different claim types.  They also have a Maximum Out of Pocket amount that caps your total costs per year (useful in the event of a major medical procedure).

As for which option is best, it is highly recommended to speak to an agent about the differences and take your personal medical and financial situation into account before deciding.

Kristin Ingram · Answer

Original Medicare is run by the federal government and allows you to see any doctor or hospital in the U.S. that accepts Medicare. Medicare Advantage is offered by private insurance companies and usually combines hospital, medical, and often drug coverage in one plan, but it typically requires you to use a network of doctors and hospitals

Answered by Kristin Ingram on March 16, 2026

Broker Licensed in FL, AZ & CA

Answered by Kristin Ingram Medicare Insurance Agent

Lisa Wohlhieter Hobbs · Answer

Think of Original Medicare and Medicare Advantage plans as an 
Ala Carte menu vs. a Prix Fixe menu.  Original Medicare (Parts A & B) is government run offering flexibility in choosing doctors, no caps offered on out-of-pocket spending, you will need to add a separate Prescription drug plan and because Original Medicare covers Hospital and Medical with co-insurances of around 20% and co-pays, and is ala-carte of your choosing, it does not include dental, vision, hearing, or any fitness benefits.  Medicare Advantage plans (Part C) are run by private companies that bundle these benefits and offer a cap on your out-of-pocket costs with regards to your hospital/medical and prescription drug coverage amounts.  Because the Medicare Advantage plans bundle your menu items, you also have a built-in prescription drug plan, along with other benefits like dental, vision, and hearing benefits in addition to extra benefits such as fitness memberships- all in one or "Prix Fixe".

Korina Medrano · Answer

Medicare is a federal benefit not an insurance. Medicare Advantage plans are low cost plans that cover what Medicare alone does not depending on where you reside and also your specific need.

Tameeka Johnson · Answer

Before choosing, understand these key differences:
1️⃣ Original Medicare (Part A & Part B)
Provided directly by the federal government
You can see any doctor or hospital nationwide that accepts Medicare
No network restrictions
You may need to purchase:
A Medigap (Supplement) plan to cover the 20% coinsurance
A separate Part D drug plan
Typically higher monthly premiums (if adding a supplement), but very predictable out-of-pocket costs
2️⃣ Medicare Advantage (Part C)
Offered by private insurance companies approved by Medicare
Usually includes:
Hospital (Part A)
Medical (Part B)
Prescription drugs (Part D)
Extra benefits like dental, vision, hearing, OTC, etc.
Often $0 additional premium (you still pay your Part B premium)
Has provider networks (HMO or PPO plans)
Has an annual maximum out-of-pocket limit
⚖️ What You Should Ask Yourself:
Do I travel frequently or live in multiple states?
Do I want freedom to see any doctor, or am I okay with a network?
Can I afford a higher monthly premium for more predictable costs?
Do I have chronic conditions that require specialists?
💡 Important: The “best” choice depends on your health, budget, doctors, and lifestyle — not just the premium.
Choosing the right plan can protect your retirement savings and reduce stress later.
If you'd like help comparing options based on your situation, feel free to reach out.

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

Jeff LeSourd · Answer

Medicare Advantage (MA) plans can save money in the short term but you need to understand how it could affect you in the medium to long term. You should fully know what MOOP - Maximum out of pocket costs are as well as copays and coinsurance. Understanding the limited Dr and hospital choices for each MA plan is critical to avoid a tragic mistake. 
Unless lack of finances completely drive this decision, you need to be really educated on the pros and cons of MA plans vs. Original Medicare.

Tetonya Lewis Charles · Answer

You should know you definitely need original Medicare A and B before you can obtain a Medicare Advantage plan.   Then the additional benefits come with the Advantage plan.

Jasmine McGehee · Answer

​Choosing the right path depends entirely on your specific situation, but working with an independent agent like myself can help you easily narrow down your best options. No matter which route you choose, Medicare Supplement or Medicare Advantage, you must enroll in and maintain both Medicare Part A and Part B. A great place to start your decision making process is by asking yourself a fundamental question: Would you prefer a higher, predictable monthly premium so you pay less out of pocket when you receive medical services, or would you rather pay a lower monthly premium and pay for services only as you need them? While this cost comparison is the perfect starting point, please keep in mind that there are several other important factors we will need to consider together to find your perfect fit.

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!!

Julio Palencia · Answer

What Are They?
Feature	Original Medicare	Medicare Advantage (MA / Part C)
Who runs it	Federal government (CMS), Private insurance companies contracted with Medicare
Structure: You have Part A (hospital) + Part B (medical). You can optionally add Part D (prescription drugs) and/or Medigap (supplement) to fill gaps.	It replaces Original Medicare; MA plans must cover what Original Medicare covers (Parts A & B) and often include drug coverage (Part D) plus extras. 
National Council on Aging
Coverage & Benefits

Core services
Medicare Advantage must provide at least the same benefits as Original Medicare (hospital, outpatient, etc.). 
Medicare Interactive


But the way services are delivered (e.g., network restrictions, prior authorizations) can differ. 
Medicare Interactive
NerdWallet


Additional benefits
Many MA plans offer extras that Original Medicare doesn’t (or only in limited form), such as vision, dental, hearing, fitness programs, telehealth, etc. 
NerdWallet
UHC
Anthem


Prescription Drugs (Part D)

With Original Medicare, you must enroll in a separate Part D plan if you want drug coverage. 
Medicare
Medicare Interactive


Most MA plans include drug coverage built in (MA-PD). 
UHC
Wikipedia


Costs & Out-of-Pocket Exposure

Premiums

With Original Medicare, many people pay no premium for Part A (if they qualify) and a standard Part B premium. 
Medicare
NerdWallet

With MA, you still pay the Part B premium and may pay an extra premium to the plan (some plans have $0 extra premium). 
UHC
Wikipedia
Medicare Interactive

Cost sharing (deductibles, copays, coinsurance)
These vary quite a bit, especially in MA plans. You’ll want to look carefully at how much you’d pay for doctor visits, hospital stays, etc. 
NerdWallet
Medicare Interactive

Out-of-Pocket Maximums

Original Medicare has no cap on how much you might have to pay in a year (unless you have supplemental coverage, li

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.

Jennise Housel · Answer

Choosing between Original Medicare and Medicare Advantage, it’s important to know that Original Medicare (Parts A and B) lets you see any doctor or hospital that accepts Medicare, but it doesn’t cover most prescriptions or limit out-of-pocket costs. You can add a Part D plan for drug coverage and a Medigap policy to help with extra costs. 

Medicare Advantage (Part C) usually includes drug coverage and extra benefits like vision, dental, and hearing, but it often limits you to a network of providers and may require referrals. 

Consider your health needs, budget, and preferred doctors before deciding.