Medicare vs Medicare Advantage

Original Medicare (Parts A and B)

Original Medicare is the traditional fee-for-service program administered by the federal government. It covers hospital care (Part A) and medical care (Part B). You can see any doctor or hospital that accepts Medicare — nationwide. There is no network restriction. However, there is no out-of-pocket maximum, meaning your costs are theoretically unlimited without supplemental coverage.

Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers approved by Medicare. They must cover everything Original Medicare covers, and most include Part D drug coverage. Many offer additional benefits like dental, vision, and hearing. Most plans have networks (HMO or PPO) and require referrals for specialists. They have out-of-pocket maximums, which can provide significant financial protection.

Cost comparison

Many Medicare Advantage plans have $0 premiums (in addition to your Part B premium). However, they typically have higher copayments and coinsurance for services, and the out-of-pocket maximum can be $8,850 or more. Original Medicare with a Medigap plan typically has higher monthly premiums but very low out-of-pocket costs when you need care.

Which is right for you?

Medicare Advantage tends to work better for people who are relatively healthy, want extra benefits like dental and vision, and prefer predictable costs. Original Medicare with Medigap tends to work better for people with serious or chronic health conditions, those who travel frequently, or those who want the freedom to see any specialist without a referral.