Original Medicare vs. Medicare Advantage: Which Should I Choose?

Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) pays for many, but not all, healthcare services and supplies. If you want extra coverage for routine medical care and even prescription drugs, Medicare Part C, also called Medicare Advantage (MA), could be the answer.

Let’s explore both types of coverage, so you can choose the best Medicare plan for you.

What’s the difference between Original Medicare and Medicare Advantage?

The main difference is Original Medicare is administered by the federal government and Medicare Advantage plans are offered by private companies. Here’s a deeper look into what makes them unique.

What is Original Medicare?

Medicare is our country’s federal health insurance program for people age 65 and older, as well as some younger people with disabilities, or any age with end-stage renal disease (ESRD). There are 2 parts:¹

Medicare Part A—generally helps cover inpatient hospital care, nursing facility care, nursing home care, hospice care and home healthcare
Medicare Part B—covers certain doctors’ services, outpatient care, medical supplies and preventive services

There are some things Original Medicare won’t cover, including long-term care and most vision, dental and hearing services.

What is Medicare Advantage?

Medicare Advantage is an alternative to traditional Medicare offered by private health insurance companies. Medicare Advantage plans cover all the same services under Original Medicare Part A and Part B, but often include prescription drug coverage and extra benefits. Some benefits may provide coverage for:²

Routine dental care (dental exams, X-rays, teeth cleanings)
Routine vision care (eye exams, eyeglasses and contacts)
Routine hearing care (hearing tests, hearing aids)
Fitness programs and gym memberships
Transportation to doctor visits
Over-the-counter drugs

Medicare Advantage plans can also include prescription drug coverage. To get the same coverage with Original Medicare, you’d have to buy a separate prescription drug plan and pay a separate premium.

Let’s compare Original Medicare and Medicare Advantage side-by-side to help you better understand each one’s advantages.

Original Medicare

Medicare Advantage (MA)

What it covers

Original Medicare helps cover hospital and doctor visits.

MA plans bundle Part A and Part B benefits, and some include prescription drug coverage. Many MA plans also include routine dental, vision and hearing care—benefits not offered by Original Medicare.

Maximum out-of-pocket cost guarantee

There is no maximum out-of-pocket cost guarantee with Original Medicare.

MA plans have a yearly limit on out-of-pocket costs for medical services, after which members pay nothing for covered services for the rest of the plan year. For 2023, in most cases the out-of-pocket maximum can be no more than $8,300.

Doctors and hospitals

If you are enrolled in Original Medicare, you can go to any doctor or hospital in the U.S. that accepts Medicare.

MA plans generally require you to use doctors and facilities in the plan's network. If you see an out-of-network provider, your costs may be higher.

Monthly premiums

You usually don't pay a monthly premium for Medicare Part A (hospital) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. You do need to pay a premium for Part B coverage. In 2023, the Medicare Part B premium is $164.90 or higher, depending on your income.

Many Medicare Advantage plans offer an affordable or $0 monthly plan premium. As with Original Medicare, Medicare Advantage members must continue to pay a monthly Part B premium ($164.90 in 2023), along with any MA plan premium.

Deductibles and coinsurance

The 2023 Part A deductible for inpatient hospital coverage is $1,600. The 2023 annual deductible for Part B medical coverage is $226.

Deductibles and copays vary depending on the Medicare Advantage plan.

Prescription drug coverage

Original Medicare does not include prescription drug coverage. You may choose to purchase a stand-alone prescription drug plan from a private company.

Most Medicare Advantage plans include coverage for prescription drugs, although there are also MA plans that cover medical services only.

Can I change my plan if I don’t like it?

Yes. You can switch from Original Medicare to Medicare Advantage, or vice versa, each year during the Medicare Open Enrollment Period, which runs from Oct. 15–Dec. 7. Also known as the Medicare Advantage and Prescription Drug Plan "annual election period" or "annual enrollment period this is the primary time when people with Medicare can choose a plan. However, there are other times during the year that may be called “open enrollment” or “special enrollment” periods when a person can enroll in a plan

What should I consider when choosing between Original Medicare and a Medicare Advantage plan?

When reviewing your options, here are some important things to remember:

Medicare cost—How much will I pay for premiums, deductibles, coinsurance and copayments?
Doctors and hospitals—Does the Medicare plan have a network? Do the healthcare providers I use accept the plan?
Medicare coverage and benefit—Does the plan include prescription drug coverage or coverage for vision, dental and hearing care?
Your health history—How often have I needed care over the past few years? Do I have a chronic condition that requires ongoing care? Do I think my healthcare needs will increase or stay about the same?

Find a Medicare plan that’s right for you

You have choices—and that’s a good thing! As you continue exploring your options, take some time to compare Medicare Advantage plans and see how to switch your Medicare plan.