If you’re approaching 65, you’re about to reach a key milestone: becoming eligible for Medicare. And one of the biggest decisions you’ll face at this time is whether to enroll in original Medicare or a Medicare Advantage plan. Both of these options will help cover your health care needs as you get older—but they work in very different ways. Understanding these differences can help you choose the plan that’s uniquely right for you.

Before we compare original Medicare and Medicare Advantage, let’s find out what each of these programs is all about.

What is original Medicare?

Original Medicare is the traditional health insurance program for older adults sponsored by the federal government. It has two main parts:

• Part A (Hospital Insurance): Helps cover inpatient hospital care, short-term care in a skilled nursing facility, hospice, and some home health care
• Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, lab tests, medical equipment, and more

There are some services original Medicare won’t cover, including long-term care delivered in the home or at an assisted living or nursing home facility. Medicare also does not cover routine physical exams, and coverage for dental, vision, and hearing care is limited to services and procedures associated to other covered diseases or conditions. Some examples of these would be eye surgery for cataracts, surgery on the ear due to a tumor inside or near ear canal, or removal of teeth during jaw surgery.

Key things to know about original Medicare

• You can see any doctor or hospital that accepts Medicare, anywhere in the U.S. If you see a provider that does not accept Medicare, you may pay more out of pocket.
• There’s no network restriction, which is helpful if you travel or have multiple doctors.
• You’ll pay a monthly premium for Part B (most people don’t pay a premium for Part A if they paid Medicare taxes while working). The standard Part B monthly premium in 2025 is $185.
• You’ll have out-of-pocket costs in the form of deductibles and coinsurance:
  • Part A has a hospital inpatient care deductible of $1,676 in 2025. Coinsurance varies based on location and length of stay.
  • Part B has a deductible of $257 in 2025. You’ll also pay a coinsurance 20% of approved costs for most Part B-covered services after you meet your deducible.
• There is no yearly limit on out-of-pocket costs.
• Prescription drug coverage is not included. You’ll need to add a separate Medicare Part D plan to get your medications covered.

Many people with original Medicare also buy a Medigap (supplemental) policy to help cover out-of-pocket costs like copayments and coinsurance.

What is Medicare Advantage?

Unlike original Medicare that comes directly from the federal government, Medicare Advantage (Part C) plans are offered by private insurance companies. These private insurers are approved by Medicare—and they must cover all the same services original Medicare does. But Medicare Advantage plans often include extra benefits.

What’s included in Medicare Advantage

• Everything original Medicare covers under Parts A and B
• Part D prescription drug coverage (most plans)
• Extra benefits original Medicare doesn’t cover, such as vision, hearing, dental, fitness programs, and even transportation to appointments (most plans)

How Medicare Advantage works

• Instead of being able to see any provider accepting Medicare assignment, you’ll need to use the plan’s network of doctors and hospitals (except in emergencies).
• Most Medicare Advantage plans operate as HMOs or PPOs. This means you may need referrals to see specialists—or pay more if you go out of network.
• Costs are structured differently in Medicare Advantage plans. For example, you may pay copayments for services instead of coinsurance percentages.
• Many plans have a $0 monthly premium, but you are still responsible for paying the Part B premium.
• Medicare Advantage plans come with an annual out-of-pocket maximum, something original Medicare does not have. This can help protect you from very high medical bills. In 2025, the out-of-pocket maximum is $9,350 for approved services (but individual plans can set lower limits if they want to).

Key Differences Between Original Medicare and Medicare Advantage

Pros and cons of original Medicare vs. Medicare Advantage

Weighing the benefits and drawbacks of the two types of Medicare plans can help you get a clearer picture of which one is a good fit for you.

✅ Original Medicare pros:

• You have the flexibility to see any provider that accepts Medicare across the U.S. This is beneficial if you travel often.
• You generally do not need a referral to see a specialist.
• Pairing it with Medigap can limit unexpected out-of-pocket costs.
• If you are interested in purchasing a Medigap policy, the first 6-months after you turn 65 and your Medicare Part B is effective is when you receive your Guaranteed Issue Rights Period. These rights ensure you can get a Medigap policy without having health problems affect your ability to buy one or pay higher premiums.

❌ Original Medicare cons:

• To get prescription coverage, you must buy a separate Part D plan and pay a monthly premium on top of the Part B premium
• Routine dental, vision, and hearing care is not covered.
• There is no annual cap on out-of-pocket spending—so if you have high medical bills, it could get very expensive.

✅ Medicare Advantage pros:

• Most plans include prescription drug coverage and extra benefits like dental, vision, and hearing care.
• Your monthly cost may be lower than having original Medicare with a separate Part D plan and Medigap policy (some Medicare Advantage plans have a $0 premium).
• All plans have an out-of-pocket spending cap that provides financial protection in the event of high medical bills.

❌ Medicare Advantage cons:

• You may be restricted to a provider network to receive covered care—and this network may not include your preferred providers.
• Plan service areas are typically limited to certain geographic locations. This means you may not have coverage if you travel to another state (unless it’s an emergency).
• You could pay a monthly premium on top of the Part B premium. Costs and coverage can vary widely by plan and location, and these terms can change every year.
• You may need a referral to see a specialist and prior authorization to receive certain types of care.

What to consider when choosing between original Medicare and Medicare Advantage

Here are a few questions to ask yourself when trying to decide between original Medicare and Medicare Advantage:

• What’s my budget? Take a look at premiums, deductibles, and maximum out-of-pocket costs for each type of plan to see which option makes financial sense. If you have low income, you may be eligible for one of the Medicare Savings Programs (MSPs). These programs supplement original Medicare or Medicare Advantage to help cover out-of-pocket expenses—and they can save you up to $2,200 yearly depending on which MSP you’re eligible for. What’s more, if you qualify for an MSP, you’ll be automatically enrolled in the Part D Low Income Subsidy (LIS, or Extra Help). This benefit helps pay for prescription drugs and is estimated to have an annual value of $6,200.
• Do I want flexibility in the providers I see? If you like having more choices in which doctors and hospitals you use, original Medicare might be a better fit. If you don’t mind having a provider network, a Medicare Advantage plan could work—but you may want to choose a plan whose network includes your favorite providers.
• Do I need extra benefits? If dental or vision care is a priority, Medicare Advantage plans usually include them. However, this coverage is not what most people envision as comprehensive coverage. Many also offer non-medical benefits like fitness memberships, transportation access, nutrition support, and annual allowances toward home safety modifications.
• How often do I travel? If you’re an avid road tripper, you may find original Medicare more convenient since coverage is nationwide. Some Medicare Advantage plans provide state-to-state travel coverage, but only in a defined area. Keep in mind that with both Medicare and Medicare Advantage, coverage for foreign travel is limited.
• What are my health needs? How often have you received care in the past few years—and do you expect this to increase? Do you have a chronic illness that requires ongoing care? Also, consider how many prescriptions you’re currently taking. Medicare Advantage plans usually include drug coverage, while original Medicare requires you to buy a separate Part D plan. No matter which path you choose, make sure your Part D plan covers the medications you need.

I’m not satisfied with my plan. Now what?

Fortunately, if you don’t like your Medicare plan, you’re not stuck with it. You do have the option to make a switch each year during Medicare Open Enrollment (also called the Annual Enrollment Period), held from Oct. 15 through Dec. 7. During this window of time, you can switch from original Medicare to a Medicare Advantage plan (or vice versa). There are also other opportunities throughout the year—sometimes called Special Enrollment Periods (SEPs)—that may allow you to sign up for, or switch, Medicare plans outside the standard enrollment timeframe.

Need help deciding? It’s yours for the asking

Choosing between original Medicare and Medicare Advantage is a personal decision. But it isn’t one you have to make alone, says Jennifer Teague, NCOA Director of Health Coverage and Benefits. “If you’re feeling overwhelmed by all the coverage options available to you, it can help to walk through them with someone who knows Medicare inside and out.”

Teague recommends that older adults contact their local State Health Insurance Assistance Program (SHIP) as a starting point. SHIPs provide free, unbiased guidance to Medicare-eligible people (and their families). Find your SHIP by visiting the program website or calling 1-877-839-2675.

You can also call Medicare directly with questions at 1-800-MEDICARE (1-800-633-4227)—or visit the Medicare.gov website to start a live chat. TTY users should call 1-877-486-2048. 

“Picking a Medicare plan can have a huge effect on your life especially if you are new to Medicare,” Teague explains. “Connecting with a Medicare specialist can help you quickly narrow down your coverage options, inform yourself on what these choices mean, and make informed enrollment decisions you feel good about.”