Original Medicare vs. Medicare Advantage?

Original Medicare is a good coverage option. But if you’re looking for more, a Medicare Advantage plan – also known as a Part C plan—comes with everything included in Original Medicare, plus prescription drug and other benefits.

Comparing Original Medicare and Medicare Advantage

Original Medicare includes Part A and Part B, which cover basic hospital and medical coverage.
Medicare Advantage (Part C) comes with Parts A and B, plus additional coverage not found in Original Medicare. This includes benefits like prescription drug coverage (Part D). Think of Medicare Advantage as an all-in-one health plan.

Here are a few differences between the two:

	Original Medicare	Medicare Advantage
Who runs this program?	Federal government	Private insurance companies
What does it cover?	Medicare Parts A and B (hospital and doctor visits).	Medicare Parts A and B, plus routine dental, vision, and hearing care. Many plans include prescription drug (Part D) coverage.
Network	You can go to any doctor or hospital in the U.S. that accepts Medicare.	You’re generally required to use in-network doctors or hospitals. Your costs may be higher if you see an out-of-network provider.
Monthly premiums	Typically no cost for Medicare Part A if you and/or a spouse paid Medicare taxes. You’ll need to pay a Part B premium.	Many Medicare Advantage plans offer low or $0 monthly premiums. You must continue to pay your Part A ($0 for most people) and Part B premiums along with your Medicare Advantage premium.
Maximum out-of-pocket cost	No maximum out-of-pocket guarantee.	Yearly maximum out-of-pocket limit on costs.
Deductibles and coinsurance	Set deductibles.	Deductibles and copays vary depending on the Medicare Advantage plan.
Can I switch plans?	You may join, drop, or switch to another Medicare Advantage plan during the Annual Enrollment Period (AEP) – from October 15 to December 7 each year. Dropping Medicare Advantage automatically returns you to Original Medicare coverage. You may also be eligible for a Special Enrollment Period (SEP) if you have a qualifying life event, such as moving from your plan’s service area or losing employer coverage.	You may join, drop, or switch to another Medicare Advantage plan during the Annual Enrollment Period (AEP) – from October 15 to December 7 each year. Dropping Medicare Advantage automatically returns you to Original Medicare coverage. You may also be eligible for a Special Enrollment Period (SEP) if you have a qualifying life event, such as moving from your plan’s service area or losing employer coverage.
*Benefits vary based on plan and location.

Original Medicare
Who runs this program?	Federal government
What does it cover?	Medicare Parts A and B (hospital and doctor visits).
Network	You can go to any doctor or hospital in the U.S. that accepts Medicare.
Monthly premiums	Typically no cost for Medicare Part A if you and/or a spouse paid Medicare taxes. You’ll need to pay a Part B premium.
Maximum out-of-pocket cost	No maximum out-of-pocket guarantee.
Deductibles and coinsurance	Set deductibles.
Can I switch plans?	You may join, drop, or switch to another Medicare Advantage plan during the Annual Enrollment Period (AEP) – from October 15 to December 7 each year. Dropping Medicare Advantage automatically returns you to Original Medicare coverage. You may also be eligible for a Special Enrollment Period (SEP) if you have a qualifying life event, such as moving from your plan’s service area or losing employer coverage.
*Benefits vary based on plan and location.

Medicare Advantage
Who runs this program?	Private insurance companies
What does it cover?	Medicare Parts A and B, plus routine dental, vision, and hearing care. Many plans include prescription drug (Part D) coverage.
Network	You’re generally required to use in-network doctors or hospitals. Your costs may be higher if you see an out-of-network provider.
Monthly premiums	Many Medicare Advantage plans offer low or $0 monthly premiums. You must continue to pay your Part A ($0 for most people) and Part B premiums along with your Medicare Advantage premium.
Maximum out-of-pocket cost	Yearly maximum out-of-pocket limit on costs.
Deductibles and coinsurance	Deductibles and copays vary depending on the Medicare Advantage plan.
Can I switch plans?	You may join, drop, or switch to another Medicare Advantage plan during the Annual Enrollment Period (AEP) – from October 15 to December 7 each year. Dropping Medicare Advantage automatically returns you to Original Medicare coverage. You may also be eligible for a Special Enrollment Period (SEP) if you have a qualifying life event, such as moving from your plan’s service area or losing employer coverage.
*Benefits vary based on plan and location.

Medicare Part A helps cover:

Hospital stays (semi-private rooms) up to 60 days
Hospital meals
Nursing services
Intensive care services
Drugs, medical supplies and equipment used on the premises
Lab tests and X-rays taken while hospitalized
Surgery and recovery costs
Rehabilitation and therapy services
Part-time home nursing care

Medicare Part B helps cover:

Doctor visits
Vaccinations and flu shots
Health screenings and medical tests
Medical supplies
Ambulance services
Smoking cessation and other preventive healthcare programs

Medicare Part C includes:

Everything in Medicare Parts A and B
Coverage for dental, hearing, vision, and prescription drugs (Part D)
Extra programs to improve your overall health and well-being

What are additional benefits of Medicare Advantage vs Original Medicare?

In addition to everything included with Original Medicare, Medicare Advantage plans offer benefits such as:

Prescription drug coverage

Many Medicare Advantage plans include prescription drug (Part D) coverage. These plans are known as Medicare Advantage Prescription Drug (MAPD) plans.

Vision care

Eye health becomes more important as we age. Eye exams, glasses, and contacts are a part of many Medicare Advantage plans.

Transportation

Rides to health appointments¹

Dental care

Many Medicare Advantage plans offer dental coverage for things like routine checkups and exams, cleanings, and dentures. They also cover unplanned dental procedures like root canals and crowns.

Hearing care

Original Medicare doesn't cover hearing aids, which can be expensive. Many Medicare Advantage plans provide hearing coverage that includes testing and medically required hearing aids.

Fitness program

Medicare Advantage plans also help you live a healthy lifestyle. Many plans include access to gym memberships, senior fitness programs like SilverSneakers®, and coaching to improve your well-being.

What about the difference in costs?