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CJ Karrer
Writer · Reviewed by Richard ChanUpdated Jun 12, 2026
11 min read
Original Medicare includes Part A and Part B and allows beneficiaries to visit any healthcare provider in the U.S. that accepts Medicare, but does not include an annual out-of-pocket maximum.
Medicare Advantage (Part C) plans are offered by private insurance companies and must provide at least the same level of coverage as Original Medicare while including an annual out-of-pocket limit.
Unlike Original Medicare, many Medicare Advantage plans bundle prescription drug coverage (Part D) and offer extra benefits such as routine dental, vision, and hearing care.
When looking at the dizzying array of options available to you for Medicare, you may have come across the term Medicare Advantage and might be wondering exactly how it compares to traditional Medicare coverage (often affectionately known as "Original Medicare").
Both Medicare Advantage and Original Medicare are alternate ways to receive your essential Medicare coverage. Medicare Advantage is quickly becoming a highly popular option, as these comprehensive plans often come with extra benefits not covered by Original Medicare, frequently at no additional premium cost.
There are, however, deeply important financial and medical considerations when it comes to deciding whether to access your Medicare through a Medicare Advantage plan or through Original Medicare.
Original Medicare and Medicare Advantage are simply two different avenues to receive your Medicare coverage when you turn 65 (or if you become otherwise eligible for Medicare due to disability).
Original Medicare is the government's standard, default health coverage and directly refers to the combination of Part A (Hospital Insurance) and Part B (Medical Insurance). Under Original Medicare, the federal government provides your health insurance directly to you without a middleman.
Most people are fortunately eligible for premium-free Part A coverage; however, everyone who enrolls in Part B is absolutely required to pay the standard Part B premium of $202.90 in 2026 (this amount may be higher depending on your past income). You will also be personally responsible for out-of-pocket costs such as deductibles, copays, and coinsurance expenses, which can quickly add up if you face a severe illness.
If you are over 65 and are a U.S. citizen, or a permanent resident who has been living in the U.S. constantly for 5 years, you are fully eligible for Medicare coverage. You will be automatically enrolled in Original Medicare if you have already started collecting your Social Security checks by the time you turn 65.
Medicare Advantage (also officially known as "Part C" coverage) is provided by private health insurance companies who are closely contracted with the federal government to deliver your Medicare benefits. Under Medicare Advantage, the government provides your health insurance indirectly by paying these Medicare Advantage plan providers a set monthly fee to manage your health insurance.
Medicare Advantage is a bundled, "all-in-one" alternate solution to Original Medicare and is required by strict federal law to provide at least the exact same coverage you would receive for Part A and Part B under Original Medicare. However, Medicare Advantage often goes further, including generous extra benefits such as Part D prescription drug coverage alongside routine dental, vision, and hearing care.
Everyone who is eligible for Original Medicare is equally eligible for Medicare Advantage. However, it's vital to know that once you enroll in a Medicare Advantage plan, you no longer receive your active coverage directly through Original Medicare, and you must receive your medical care in strict accordance with your private plan provider's rules and network policies.
You will still need to pay your standard Part B premium if you are enrolled in a Medicare Advantage plan. You may also be required to pay an additional monthly premium directly to the plan provider, depending entirely on the specific plan you confidently choose.
Medicare Advantage is absolutely not the same as, and should never be confused with, Medicare Supplement (also known as "Medigap") insurance. Medigap is separate supplemental coverage you can proactively purchase to help cover the steep out-of-pocket costs of Original Medicare. Read our article on Medigap vs. Medicare Advantage for more clarity.
Health insurance companies that provide Medicare Advantage plans are required by law to deliver at least the exact same coverage as the Part A and Part B insurance you would receive under Original Medicare.
However, there are some serious differences to consider when you are deciding whether you want to receive your coverage through Original Medicare versus Medicare Advantage:
| Original Medicare | Medicare Advantage | |
| Part A (Hospital) | Part A reliably covers: – Inpatient care in a hospital – Inpatient care in a skilled nursing facility (not custodial or long-term care) – Hospice care – Home health care | Medicare Advantage includes bundled Part A + Part B coverage and must legally cover the same services as Original Medicare. |
| Part B (Medical) | Part B covers: – Doctor services and essential tests – Outpatient care – Home health services – Durable medical equipment – Some crucial preventive services | Medicare Advantage includes bundled Part A + Part B coverage and covers the same services as Original Medicare. |
| Part D (Prescription) | Not included – you will need to purchase a separate Prescription Drug Plan (PDP) at an additional cost to afford your medications. | Prescription drug coverage is conveniently included in most plans. |
| Doctor Network | Any doctor or hospital that takes Medicare, anywhere across the U.S. | You generally need to use doctors who are strictly in the plan's network (for non-emergency or non-urgent care). |
| Select a Primary Care Doctor? | No | Depending on the plan type: – HMO / HMO-POS / SNP plan: Yes – PFFS / PPO plan: No |
| Specialist Referrals | No | Depending on the plan type: – HMO / HMO-POS / SNP plan: Yes – PFFS / PPO plan: No |
| Additional Benefits | Does not offer additional benefits like routine dental, vision, and hearing. | May generously offer extra benefits such as dental, vision, hearing, OTC drug coverage, fitness benefits, free transportation, and more. |
With Original Medicare, you have the ultimate freedom to use any doctor or hospital that takes Medicare, anywhere in the U.S. While the CMS (the Centers for Medicare and Medicaid Services) does not publicly track specifically how many doctors in the U.S. accept Medicare patients, Kaiser Family Foundation research has thankfully found that 93% of primary care providers surveyed accepted Medicare. However, only 72% of them were taking on new Medicare patients.
With Medicare Advantage, you'll in most cases need to proactively use doctors who are locked in the plan's specific network. Some plans may offer out-of-network coverage, but often at a painfully higher cost to your wallet.
You may be familiar with HMO or PPO structures if you have previously had group or employer-sponsored insurance. Each type of plan has different, strict restrictions in terms of which doctor and hospital networks are truly accessible to you. SNPs are specially made available to help deliver integrated care that better suits the intense needs of special needs beneficiaries, such as those struggling with chronic conditions.
You may also occasionally come across Private-Fee-for-Service (PFFS) and Medical Savings Accounts (MSA) plans, which are far less common (less than 1% of enrollees use these plans). These types of plans may offer a wider network than standard HMO and PPO options.
Original Medicare absolutely does not come with Prescription Drug Coverage (also known as Medicare Part D). In order to get coverage for your vital prescriptions with Original Medicare, you need to purchase a separate Prescription Drug Plan (PDP) from a private health insurance company. This means you must pay an additional, separate premium each and every month.
In 2026, 89% of Medicare Advantage plans conveniently offer prescription drug coverage seamlessly included (these are known as 'MA-PD' plans). You are incredibly not required to pay a separate monthly premium for drugs with these MA-PD plans.
Medicare Advantage plans often offer fantastic extra benefits that Original Medicare simply doesn't cover—like vision, hearing, dental, and wellness programs (such as free gym memberships). This is a huge reason why Medicare Advantage plans have been rapidly gaining popularity amongst seniors across the country who want to save money in recent years.
In 2021, most Medicare Advantage plans also offered extra benefits far beyond what Original Medicare reliably covers, including fitness (99%), dental (97%), vision (99%), and hearing (97%). Nearly three-quarters (71%) of Medicare Advantage plans provided a helpful meal benefit and 43% provided some form of transportation benefit to help you get to your appointments safely.
Health insurance companies are also increasingly covering even more additional extra benefits than they have in the past, including innovative services like telehealth, over-the-counter drugs, adult day-care services, and other health-related services that actively promote your long-term health and wellness.
This is a massive win for you as the consumer, and you should absolutely check your options annually to make completely sure you are getting the most out of the plans available in your area.
Premiums are the mandatory monthly payments you need to consistently make in order to keep your insurance coverage securely in place.
Regardless if you are selecting Medicare Advantage or Original Medicare you are strictly required to pay your Part B premium (and any Part A premium, if applicable).
The standard Part B premium amount in 2026 is $202.90 per month, although you may sadly need to pay a higher premium depending on your income. Each year, Medicare premiums, deductibles, and copayment rates are adjusted in accordance with the Social Security Act.
Under Original Medicare, if you proactively choose to purchase a standalone Part D Prescription Drug Plan (PDP), you'll pay that premium entirely separately.
For Medicare Advantage, you may need to pay an extra premium for the plan in addition to your monthly premium for Part B, depending precisely on the coverage you choose.
However, in 2026, a stunning 99% of Medicare beneficiaries will have access to an MA-PD with a '$0 premium'.
| What is a "$0 premium" Medicare Advantage Plan? Medicare Advantage plans can be advertised as "$0 premium" plans. This simply means that there is no additional premium charged on top of your Part A (if applicable) and Part B premium that you are already reliably paying. In 2020, nearly two-thirds (60%) of Medicare Advantage enrollees paid absolutely no premium (other than the required Part B premium). For more helpful information read our article on $0 premium plans. |
Out-of-pocket costs are the stressful expenses that are not reimbursed by Medicare and include unpredictable costs such as deductibles, co-pays, and coinsurance:
Deductibles, co-pays, and co-insurance will vary wildly depending on whether you receive your coverage through Original Medicare or Medicare Advantage. The major differences between the two that you must highlight are:
The honest answer, as with most complex health and financial services questions, is that it completely depends. The cost-benefit equation will come right down to your unique health situation as well as your personal health-related and financial preferences. In particular, ask yourself: