Everyone with Medicare gets their coverage one of two ways: Original Medicare (Parts A and B, from the federal program) or a Medicare Advantage plan (Part C, from a private plan). Neither is better for everyone. Here's what actually differs.
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Choice of doctors | Any doctor or hospital in the U.S. that accepts Medicare | Usually a network; rules depend on the plan type |
| Referrals | Generally not needed | Often needed in HMO plans |
| Yearly out-of-pocket limit | None on its own | Yes, every plan has one |
| Drug coverage | Add a stand-alone Part D plan | Usually included |
| Supplement (Medigap) | Can be added to cover gaps | Can't be used with a plan |
| Extra benefits | Generally no routine dental, vision or hearing | Often includes some |
| Prior authorization | Rarely required | Can be required for some services |
| Travel within the U.S. | Coverage goes with you | Outside the service area, often only emergencies and urgent care |
The trade-off in one sentence
Original Medicare trades a cost limit for freedom of choice; Medicare Advantage trades freedom of choice for a cost limit and, often, extras. Adding a Medigap policy to Original Medicare is how many people get both freedom and predictable costs — at the price of a separate premium.
Think about switching back before you switch. If you leave Original Medicare for a Medicare Advantage plan and later want to return, you may not be able to buy a Medigap policy without medical underwriting, depending on your state and circumstances. That makes the first choice more important than it looks.
Questions that usually decide it
- Are the doctors and hospitals you rely on in the plan's network?
- Do you spend part of the year in another state?
- How would you handle the costs in a year with a serious illness?
- Are your prescriptions covered, and at what tier?
Free, unbiased help is available from your State Health Insurance Assistance Program (SHIP), and at Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048).
The Medicare cheat sheet
Parts A, B, C and D on a single page, plus the dates that matter this fall. The email version is coming soon.