What is the Big Difference Between Medicare and Medicare Advantage?

October 04, 2025•5 min read

Understanding Original Medicare

Original Medicare is a federal program that provides health care coverage to eligible individuals, primarily those aged 65 and older. It consists of two main parts: Medicare Part A and Medicare Part B. Medicare Part A covers hospital stays, skilled nursing facility care, and some home health care. Part B covers outpatient care, doctor visits, and preventive services.

Original Medicare is a fee-for-service program where you pay a portion of the costs through deductibles and coinsurance. While it covers many health care services, it does not provide coverage for everything, such as dental, vision, or hearing care. Prescription drug coverage is also not included, but you can sign up for a separate Medicare Part D prescription drug plan to help with these costs.

Original Medicare and Medicare Advantage

While Original Medicare offers a broad range of coverage, many people look for additional benefits. This is where Medicare Advantage Plans come in. Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare.

Medicare Advantage Plans include all the benefits of Medicare Part A and Part B, and often offer extra benefits that Original Medicare doesn't cover, such as dental, vision, and hearing services. Some plans also include prescription drug coverage, making it easier to manage your health care needs under one plan.

Exploring Medicare Advantage Plans

Medicare Advantage Plans are a popular choice for those who want more comprehensive coverage. These plans may offer lower out-of-pocket costs compared to Original Medicare. However, they often require you to use a network of doctors and hospitals, which can limit your choices. When considering Medicare Advantage, it's important to review the plan's network and coverage options.

Medicare Advantage Plans can vary in terms of costs, including premiums, deductibles, and copayments. Some plans may have lower premiums but higher out-of-pocket costs, while others might have higher premiums but more comprehensive coverage. It's essential to compare different plans to find one that fits your health care needs and budget.

Medigap: Medicare Supplement Insurance

For those who choose to stay with Original Medicare, a Medicare Supplement plan, also known as Medigap, can help cover some of the costs that Original Medicare doesn't. Medigap Plans are sold by private companies and can help pay for out-of-pocket costs like copayments, coinsurance, and deductibles.

Medigap policies are standardized and offer different levels of coverage. They don't cover prescription drugs, so if you need drug coverage, you'll need to enroll in a separate Medicare Part D plan. It's important to note that you cannot have a Medigap policy and a Medicare Advantage Plan at the same time.

Difference Between Original Medicare and Medicare Advantage

Original Medicare: Federal program, includes Part A and Part B, doesn't cover dental or vision, and requires separate Part D for drug coverage.
Medicare Advantage: Private plans, includes Part A and Part B, often covers additional benefits like dental and vision, and may include drug coverage.

The main difference between Original Medicare and Medicare Advantage is the way benefits are delivered and the additional services available through Medicare Advantage Plans. While Original Medicare provides flexibility in choosing providers, Medicare Advantage often offers more comprehensive coverage at potentially lower costs.

Switching from Original Medicare to Medicare Advantage

If you're considering a switch from Original Medicare to Medicare Advantage, there are several factors to keep in mind:

Compare the benefits and costs of the plans available in your area.
Check if your preferred doctors and hospitals accept the Medicare Advantage Plan you're considering.
Review the plan's drug coverage if you take prescription medications regularly.

It's also possible to switch from Medicare Advantage back to Original Medicare during certain enrollment periods if you find that the plan doesn't meet your needs.

Choosing Between Original Medicare and Medicare Advantage

Deciding between Original Medicare and a Medicare Advantage Plan depends on your personal health care needs and preferences. Consider the following when choosing:

Your health care needs and the services you use most often.
The importance of having access to specific doctors and hospitals.
Your budget for premiums and out-of-pocket costs.
The value of additional benefits like dental, vision, and hearing coverage.

By understanding the coverage options and weighing the pros and cons of each plan, you can choose the best Medicare Plan for your needs.

Medicare Supplement Plans: An Overview

Medicare Supplement plans, or Medigap, can be an excellent choice for those who prefer to stay with Original Medicare. These plans help cover costs that Medicare Parts A and B do not, such as deductibles and coinsurance.

While Medigap offers added financial protection, it's important to remember that it doesn't cover everything. Prescription drug coverage requires a separate Part D plan. When selecting a Medigap policy, compare different plans and consider what additional costs each plan may cover.

How to Choose the Best Medicare Plan

Choosing the best Medicare Plan involves understanding your health care needs and financial situation. Here are some steps to guide your decision:

List your current health care providers and check if they accept Medicare Advantage Plans you are considering.
Evaluate your prescription drug needs and compare the drug coverage offered by various plans.
Determine your budget for premiums and out-of-pocket costs, and find a plan that aligns with your financial situation.
Consider the additional benefits and services you value, such as dental, vision, or wellness programs.
Review the plan's network restrictions and ensure they fit your lifestyle and health care requirements.

By carefully evaluating these factors, you can make an informed choice between Original Medicare and Medicare Advantage.